Basic Information
| Provider Information | |||||||||
| NPI: | 1811015613 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ZIESKE | ||||||||
| FirstName: | PAGE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCPC | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 1619 E. 10TH STREET | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671142512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167555871 | ||||||||
| FaxNumber: | 6206635263 | ||||||||
| Practice Location | |||||||||
| Address1: | 1619 E. 10TH STREET | ||||||||
| Address2: | |||||||||
| City: | NEWTON | ||||||||
| State: | KS | ||||||||
| PostalCode: | 671142512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167555871 | ||||||||
| FaxNumber: | 6206635263 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2007 | ||||||||
| LastUpdateDate: | 09/01/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/01/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | 3317 | ID | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 1020 | MT | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 3317 | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | 2347 | KS | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LCPC-55289 | MT | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LCPC-8769 | ID | N | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | LCPC-2347 | KS | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.