=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699568238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY JOAN GEISLINGER LADC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/27/2025
-----------------------------------------------------
Last Update Date | 05/27/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 180 NE 6TH ST
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55744-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-328-6434
-----------------------------------------------------
Fax | 218-328-6435
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 180 NE 6TH ST
-----------------------------------------------------
City | GRAND RAPIDS
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55744-2873
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 218-328-6434
-----------------------------------------------------
Fax | 218-328-6435
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 302965
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------