Provider Demographics
NPI:1851845184
Name:GEISSLER, KIMBERLY (HIS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:GEISSLER
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:
Other - Last Name:MICHALAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:HIS
Mailing Address - Street 1:817 REYNOLDS RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1312
Mailing Address - Country:US
Mailing Address - Phone:607-743-3999
Mailing Address - Fax:
Practice Address - Street 1:800 HOOPER RD STE 370
Practice Address - Street 2:
Practice Address - City:ENDWELL
Practice Address - State:NY
Practice Address - Zip Code:13760-1588
Practice Address - Country:US
Practice Address - Phone:607-786-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
14000039754237700000X
NY14000039754237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist