Provider Demographics
NPI:1407156490
Name:SKALESKI, GARY FRANK (LPC)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:FRANK
Last Name:SKALESKI
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 ELM GROVE RD STE 100
Mailing Address - Street 2:
Mailing Address - City:ELM GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53122-2546
Mailing Address - Country:US
Mailing Address - Phone:262-782-2090
Mailing Address - Fax:262-782-2002
Practice Address - Street 1:500 ELM GROVE RD STE 100
Practice Address - Street 2:
Practice Address - City:ELM GROVE
Practice Address - State:WI
Practice Address - Zip Code:53122-2546
Practice Address - Country:US
Practice Address - Phone:262-782-2090
Practice Address - Fax:262-782-2002
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4205-125101YP2500X
IL180.000368101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional