Provider Demographics
NPI:1740955368
Name:GEISENDORFER, VALERIE KAYE (LICSW)
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:KAYE
Last Name:GEISENDORFER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:VALERIE
Other - Middle Name:KAYE
Other - Last Name:KLINGBERG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1155 NORTHLAND DR
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120-1288
Mailing Address - Country:US
Mailing Address - Phone:608-770-8892
Mailing Address - Fax:
Practice Address - Street 1:1385 MENDOTA HEIGHTS RD STE 200
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120-1289
Practice Address - Country:US
Practice Address - Phone:952-652-1067
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-16
Last Update Date:2023-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical