Provider Demographics
NPI:1477987915
Name:MIESZALA, JENNIFER EILEEN (LCSW, CADC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:EILEEN
Last Name:MIESZALA
Suffix:
Gender:F
Credentials:LCSW, CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 RENAISSANCE DR
Mailing Address - Street 2:#101
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-1329
Mailing Address - Country:US
Mailing Address - Phone:847-963-9639
Mailing Address - Fax:312-902-2665
Practice Address - Street 1:1400 RENAISSANCE DR
Practice Address - Street 2:#101
Practice Address - City:PARK RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60068-1329
Practice Address - Country:US
Practice Address - Phone:847-963-9639
Practice Address - Fax:312-902-2665
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-31
Last Update Date:2014-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL20754101YA0400X
IL150013502104100000X
IL1490167281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker