Provider Demographics
NPI:1972031508
Name:WASILEWSKI, MICHAEL ANDREW (LCSW)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:WASILEWSKI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 E HILLSIDE RD
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-6705
Mailing Address - Country:US
Mailing Address - Phone:630-244-1751
Mailing Address - Fax:630-527-8877
Practice Address - Street 1:24047 W LOCKPORT ST STE 201F
Practice Address - Street 2:
Practice Address - City:PLAINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60544-1680
Practice Address - Country:US
Practice Address - Phone:630-527-8877
Practice Address - Fax:630-527-8877
Is Sole Proprietor?:No
Enumeration Date:2017-05-26
Last Update Date:2022-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150102473104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker