Provider Demographics
NPI:1851871420
Name:KISELOFF, ALEXANDER (LISW-S, LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:KISELOFF
Suffix:
Gender:M
Credentials:LISW-S, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:262 ALPINE SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:VERNON HILLS
Mailing Address - State:IL
Mailing Address - Zip Code:60061-2308
Mailing Address - Country:US
Mailing Address - Phone:773-342-0210
Mailing Address - Fax:224-424-6829
Practice Address - Street 1:262 ALPINE SPRINGS DR
Practice Address - Street 2:
Practice Address - City:VERNON HILLS
Practice Address - State:IL
Practice Address - Zip Code:60061-2308
Practice Address - Country:US
Practice Address - Phone:773-340-1441
Practice Address - Fax:224-424-6829
Is Sole Proprietor?:No
Enumeration Date:2018-08-14
Last Update Date:2024-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.17011451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical