Provider Demographics
NPI:1063660884
Name:VASILESKI, ALEXANDER SIMON
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:SIMON
Last Name:VASILESKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ALEXANDER
Other - Middle Name:SIMON
Other - Last Name:VASILESKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BCS, PSD
Mailing Address - Street 1:370 N BATEMAN CIR
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-7612
Mailing Address - Country:US
Mailing Address - Phone:224-249-1972
Mailing Address - Fax:
Practice Address - Street 1:370 N BATEMAN CIR
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-7612
Practice Address - Country:US
Practice Address - Phone:224-249-1972
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-04
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist