Provider Demographics
NPI:1205527967
Name:VORISEK, THOMAS JOSEPH
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JOSEPH
Last Name:VORISEK
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 1:725 GLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4414
Mailing Address - Country:US
Mailing Address - Phone:312-350-2994
Mailing Address - Fax:
Practice Address - Street 1:1318 WAUKEGAN RD
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-3022
Practice Address - Country:US
Practice Address - Phone:312-350-2994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-15
Last Update Date:2024-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician