Provider Demographics
NPI:1619102290
Name:GEISNER, MARI KATHLEEN
Entity Type:Individual
Prefix:
First Name:MARI
Middle Name:KATHLEEN
Last Name:GEISNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1271 BOULDER DR APT 116
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82601-6121
Mailing Address - Country:US
Mailing Address - Phone:307-333-4293
Mailing Address - Fax:
Practice Address - Street 1:3055 E 3RD ST
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82609-2107
Practice Address - Country:US
Practice Address - Phone:307-333-4293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-26
Last Update Date:2016-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No251S00000XAgenciesCommunity/Behavioral Health