Provider Demographics
NPI:1588860662
Name:DASSINGER, GERALD MATHIAS (LICSW)
Entity Type:Individual
Prefix:
First Name:GERALD
Middle Name:MATHIAS
Last Name:DASSINGER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:GARY
Other - Middle Name:M
Other - Last Name:DASSINGER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:9911 45TH ST SW
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:ND
Mailing Address - Zip Code:58630-9744
Mailing Address - Country:US
Mailing Address - Phone:701-483-9911
Mailing Address - Fax:
Practice Address - Street 1:11 2ND AVE E
Practice Address - Street 2:SUITE B
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-5218
Practice Address - Country:US
Practice Address - Phone:701-483-9720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND22351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical