Provider Demographics
NPI:1174703136
Name:CIESIELSKI, HEATHER A (PHD)
Entity type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:A
Last Name:CIESIELSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HEATHER
Other - Middle Name:A
Other - Last Name:KAISER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:3333 BURNET AVENUE
Mailing Address - Street 2:ML 5013
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45229-3026
Mailing Address - Country:US
Mailing Address - Phone:513-636-5013
Mailing Address - Fax:513-636-2511
Practice Address - Street 1:3333 BURNET AVENUE
Practice Address - Street 2:ML 3015
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45229-3026
Practice Address - Country:US
Practice Address - Phone:513-636-4336
Practice Address - Fax:513-636-3677
Is Sole Proprietor?:No
Enumeration Date:2007-11-07
Last Update Date:2012-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2696103T00000X
OH6931103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39157000Medicaid
WI39157000Medicaid