Provider Demographics
NPI:1598104861
Name:GEISSMAN, CHARLEEN MARIE (MS)
Entity Type:Individual
Prefix:MRS
First Name:CHARLEEN
Middle Name:MARIE
Last Name:GEISSMAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:CHARLEEN
Other - Middle Name:MARIE
Other - Last Name:BACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6222 94TH AVE
Mailing Address - Street 2:
Mailing Address - City:KENOSHA
Mailing Address - State:WI
Mailing Address - Zip Code:53142-8233
Mailing Address - Country:US
Mailing Address - Phone:262-496-8735
Mailing Address - Fax:262-997-1121
Practice Address - Street 1:6222 94TH AVE
Practice Address - Street 2:
Practice Address - City:KENOSHA
Practice Address - State:WI
Practice Address - Zip Code:53142-8233
Practice Address - Country:US
Practice Address - Phone:262-496-8735
Practice Address - Fax:262-997-1121
Is Sole Proprietor?:No
Enumeration Date:2013-06-20
Last Update Date:2020-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst