Provider Demographics
NPI:1285006528
Name:GRIESEMER, WESLEY (BS)
Entity Type:Individual
Prefix:MR
First Name:WESLEY
Middle Name:
Last Name:GRIESEMER
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 MICAH DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:IL
Mailing Address - Zip Code:62450-4720
Mailing Address - Country:US
Mailing Address - Phone:618-395-4309
Mailing Address - Fax:618-395-4507
Practice Address - Street 1:504 MICAH DR
Practice Address - Street 2:DRAWER M
Practice Address - City:OLNEY
Practice Address - State:IL
Practice Address - Zip Code:62450-4720
Practice Address - Country:US
Practice Address - Phone:618-395-4309
Practice Address - Fax:618-395-4507
Is Sole Proprietor?:No
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)