Provider Demographics
NPI:1083883128
Name:GEIDNER, JAMES M (LCPC)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:M
Last Name:GEIDNER
Suffix:
Gender:M
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 N. 34TH STREET
Mailing Address - Street 2:SUITE 300
Mailing Address - City:SUPERIOR
Mailing Address - State:WI
Mailing Address - Zip Code:54880-4500
Mailing Address - Country:US
Mailing Address - Phone:218-310-1693
Mailing Address - Fax:888-724-4599
Practice Address - Street 1:1500 N 34TH ST
Practice Address - Street 2:SUITE 300
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-4477
Practice Address - Country:US
Practice Address - Phone:218-310-1693
Practice Address - Fax:888-724-4599
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-22
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3788-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional