Provider Demographics
NPI:1083210157
Name:GEIGER, KAITLIN ELIZABETH (LLC)
Entity type:Individual
Prefix:
First Name:KAITLIN
Middle Name:ELIZABETH
Last Name:GEIGER
Suffix:
Gender:F
Credentials:LLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7268 E ATWATER RD
Mailing Address - Street 2:
Mailing Address - City:RUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48470-9777
Mailing Address - Country:US
Mailing Address - Phone:810-824-2665
Mailing Address - Fax:
Practice Address - Street 1:6627 ROSE ST
Practice Address - Street 2:
Practice Address - City:CASS CITY
Practice Address - State:MI
Practice Address - Zip Code:48726-1262
Practice Address - Country:US
Practice Address - Phone:989-872-1800
Practice Address - Fax:989-872-1801
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X, 390200000X, 101YP2500X
MI106S00000X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No251S00000XAgenciesCommunity/Behavioral Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program