Provider Demographics
NPI:1639836497
Name:JESIOLOWSKI, BERNARD STEVE
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:STEVE
Last Name:JESIOLOWSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 HIGH ST STE A
Mailing Address - Street 2:
Mailing Address - City:WADSWORTH
Mailing Address - State:OH
Mailing Address - Zip Code:44281-1690
Mailing Address - Country:US
Mailing Address - Phone:208-313-4093
Mailing Address - Fax:
Practice Address - Street 1:680 HIGH ST STE A
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-1690
Practice Address - Country:US
Practice Address - Phone:330-690-2337
Practice Address - Fax:330-822-6955
Is Sole Proprietor?:No
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional