Provider Demographics
NPI:1811015613
Name:ZIESKE, PAGE MARIE (LCPC)
Entity Type:Individual
Prefix:MS
First Name:PAGE
Middle Name:MARIE
Last Name:ZIESKE
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 E. 10TH STREET
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-2512
Mailing Address - Country:US
Mailing Address - Phone:316-755-5871
Mailing Address - Fax:620-663-5263
Practice Address - Street 1:1619 E. 10TH STREET
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-2512
Practice Address - Country:US
Practice Address - Phone:316-755-5871
Practice Address - Fax:620-663-5263
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID3317101YP2500X
MT1020101YP2500X
3317101YP2500X
KS2347101YP2500X
MTLCPC-55289101YP2500X
IDLCPC-8769101YP2500X
KSLCPC-2347101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty