Provider Demographics
NPI:1609285865
Name:GESING, MICHELLE L (PSYD)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:L
Last Name:GESING
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2540 HAUSER ROSS DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:SYCAMORE
Mailing Address - State:IL
Mailing Address - Zip Code:60178-3148
Mailing Address - Country:US
Mailing Address - Phone:815-758-8400
Mailing Address - Fax:815-758-8441
Practice Address - Street 1:2540 HAUSER ROSS DR
Practice Address - Street 2:SUITE 225
Practice Address - City:SYCAMORE
Practice Address - State:IL
Practice Address - Zip Code:60178-3148
Practice Address - Country:US
Practice Address - Phone:815-758-8400
Practice Address - Fax:815-758-8441
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-12
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008884103TC0700X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling