Healthcare Provider Details

I. General information

NPI: 1043052095
Provider Name (Legal Business Name): ALBERT GESIERICH LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2024
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 W LAKE LANSING RD STE C125
EAST LANSING MI
48823-8485
US

IV. Provider business mailing address

714 MAPLE ST
GRAND LEDGE MI
48837-1817
US

V. Phone/Fax

Practice location:
  • Phone: 517-927-6748
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801122899
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: