Provider Demographics
NPI:1790066603
Name:GIESKE, ERIC JOHN
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:JOHN
Last Name:GIESKE
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 1:814 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48198-3006
Mailing Address - Country:US
Mailing Address - Phone:734-395-8375
Mailing Address - Fax:
Practice Address - Street 1:814 CHARLES ST
Practice Address - Street 2:
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48198-3006
Practice Address - Country:US
Practice Address - Phone:734-395-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker