Provider Demographics
NPI:1750627139
Name:GEISER, LYNN MARIE (MS, MFT-IT, PC-IT)
Entity type:Individual
Prefix:MRS
First Name:LYNN
Middle Name:MARIE
Last Name:GEISER
Suffix:
Gender:F
Credentials:MS, MFT-IT, PC-IT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 S 8TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-4463
Mailing Address - Country:US
Mailing Address - Phone:920-323-7431
Mailing Address - Fax:920-358-5970
Practice Address - Street 1:615 S 8TH ST
Practice Address - Street 2:SUITE 220
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081-4463
Practice Address - Country:US
Practice Address - Phone:920-323-2188
Practice Address - Fax:920-358-5970
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2012-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1583-226101YP2500X
WI236-228106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional