Provider Demographics
NPI:1528393543
Name:GEISNER, IRENE MARKMAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:IRENE
Middle Name:MARKMAN
Last Name:GEISNER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 50095
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98145-5095
Mailing Address - Country:US
Mailing Address - Phone:206-419-8999
Mailing Address - Fax:
Practice Address - Street 1:4225 ROOSEVELT WAY NE
Practice Address - Street 2:SUITE 306
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6099
Practice Address - Country:US
Practice Address - Phone:206-598-7792
Practice Address - Fax:206-598-7794
Is Sole Proprietor?:No
Enumeration Date:2009-10-08
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60061873103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical