Provider Demographics
NPI:1164035259
Name:KIESZ, SUZANNE PAULINE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SUZANNE
Middle Name:PAULINE
Last Name:KIESZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:CREEKSIDE COUNSELING ASSOCIATES
Mailing Address - Street 2:8861 WILLIAMSON DRIVE, SUITE 40
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1878
Mailing Address - Country:US
Mailing Address - Phone:916-842-5229
Mailing Address - Fax:916-670-7880
Practice Address - Street 1:CREEKSIDE COUNSELING ASSOCIATES
Practice Address - Street 2:8861 WILLIAMSON DRIVE, SUITE 40
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1878
Practice Address - Country:US
Practice Address - Phone:916-842-5229
Practice Address - Fax:916-670-7880
Is Sole Proprietor?:No
Enumeration Date:2020-08-28
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW832161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical