Provider Demographics
NPI:1548242753
Name:GIESEKE, WILLIAM DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:DAVID
Last Name:GIESEKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:788 W FRONTAGE ROAD
Mailing Address - Street 2:SUITE 122
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1209
Mailing Address - Country:US
Mailing Address - Phone:847-446-0240
Mailing Address - Fax:
Practice Address - Street 1:1850 OAK STREET
Practice Address - Street 2:SUITE 240
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3028
Practice Address - Country:US
Practice Address - Phone:847-446-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-15
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180-002489101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health