Individual
MR. JEFFREY ALLEN CIESLAK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LAT,AT,C, EMT
Contact information
Practice address
400 W RIVERWOODS PKWY, GLENDALE, WI 53212
(414) 465-3000
Mailing address
34565 MEADOW VIEW CT, OCONOMOWOC, WI 53066-8778
(262) 853-1629
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
0000195-039
WI
Other
Enumeration date
01/21/2015
Last updated
01/21/2015
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