Provider Demographics
NPI:1477157402
Name:GEIER, JOHN G (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:G
Last Name:GEIER
Suffix:
Gender:M
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9513 W TEE LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-3944
Mailing Address - Country:US
Mailing Address - Phone:903-816-0198
Mailing Address - Fax:
Practice Address - Street 1:1321 E POPLAR ST
Practice Address - Street 2:
Practice Address - City:DEMING
Practice Address - State:NM
Practice Address - Zip Code:88030-4807
Practice Address - Country:US
Practice Address - Phone:575-546-5951
Practice Address - Fax:575-546-5994
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP7269235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist