Provider Demographics
NPI:1184604639
Name:GEERTSEN, DENNIS C (LCSW)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:C
Last Name:GEERTSEN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:DR
Other - First Name:DENNIS
Other - Middle Name:C
Other - Last Name:GEERTSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW, PHD
Mailing Address - Street 1:1020 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84101-3176
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1020 S MAIN ST
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-3176
Practice Address - Country:US
Practice Address - Phone:801-539-7087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT140085-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTU000075212Medicare PIN
UT002200231Medicare PIN