Provider Demographics
NPI:1063772648
Name:SIELSKI, JENNIFER (LPC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:SIELSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MANISTEE
Mailing Address - State:MI
Mailing Address - Zip Code:49660-1232
Mailing Address - Country:US
Mailing Address - Phone:231-510-7119
Mailing Address - Fax:844-801-8605
Practice Address - Street 1:115 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MANISTEE
Practice Address - State:MI
Practice Address - Zip Code:49660-1232
Practice Address - Country:US
Practice Address - Phone:231-510-7119
Practice Address - Fax:844-801-8605
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-17
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012601101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional