MEDICARE: MRS. TERESA CIESLINSKI LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801-057441	MI

General Provider Information

NPI Number	:	1538269055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TERESA CIESLINSKI LMSW

Provider Business Mailing Address
First Line	:	300 68TH ST SE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49548-6927
Country	:	US
Telephone Number	:	616-455-5000
Fax Number	:

Provider Business Practice Location Address
First Line	:	700 HAMMOND RD E
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-8641
Country	:	US
Telephone Number	:	231-947-2255
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/24/2006
Last Update Date	:	12/02/2024

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