MEDICARE: DIANE L GEISEN, LSCSW, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1619062049	OTHER		NPPES

General Provider Information

NPI Number	:	1962961540
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIANE L GEISEN, LSCSW, LLC

Provider Business Mailing Address
First Line	:	114A S 7TH ST
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-2806
Country	:	US
Telephone Number	:	785-827-2700
Fax Number	:	785-576-1199

Provider Business Practice Location Address
First Line	:	114A S 7TH ST
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-2806
Country	:	US
Telephone Number	:	785-827-2700
Fax Number	:	785-576-1199

Authorized Official
Title or Position	:	OWNER/PRACTITIONER
Name	:	DIANE GEISEN
Credential	:	LSCSW
Telephone Number	:	785-827-2700

Provider Enumeration Date	:	03/13/2019
Last Update Date	:	08/01/2022

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