Healthcare Provider Details

I. General information

NPI: 1154328649
Provider Name (Legal Business Name): GERI C WILIMEK LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 BELTRAMI AVE NW STE 102
BEMIDJI MN
56601-3010
US

IV. Provider business mailing address

514 BELTRAMI AVE NW STE 102
BEMIDJI MN
56601-3010
US

V. Phone/Fax

Practice location:
  • Phone: 218-209-8234
  • Fax:
Mailing address:
  • Phone: 218-209-8234
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number9116
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: