Provider Demographics
NPI:1699568238
Name:GEISLINGER, KIMBERLY JOAN (LADC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JOAN
Last Name:GEISLINGER
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 NE 6TH ST
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MN
Mailing Address - Zip Code:55744-2873
Mailing Address - Country:US
Mailing Address - Phone:218-328-6434
Mailing Address - Fax:218-328-6435
Practice Address - Street 1:180 NE 6TH ST
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MN
Practice Address - Zip Code:55744-2873
Practice Address - Country:US
Practice Address - Phone:218-328-6434
Practice Address - Fax:218-328-6435
Is Sole Proprietor?:No
Enumeration Date:2025-05-27
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302965101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)