Provider Demographics
NPI:1376905174
Name:KESSEN, GEORJEAN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:GEORJEAN
Middle Name:
Last Name:KESSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2195 IRONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2628
Mailing Address - Country:US
Mailing Address - Phone:208-769-2771
Mailing Address - Fax:208-769-1430
Practice Address - Street 1:2195 IRONWOOD CT
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2628
Practice Address - Country:US
Practice Address - Phone:208-769-2771
Practice Address - Fax:208-769-1430
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLMSW-30297104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker