Provider Demographics
NPI:1144323544
Name:GEISEMAN, SANDRA D (MS, LCPC, NCC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:D
Last Name:GEISEMAN
Suffix:
Gender:F
Credentials:MS, LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 E WINNESHIEK RD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:IL
Mailing Address - Zip Code:61032-8991
Mailing Address - Country:US
Mailing Address - Phone:815-449-2037
Mailing Address - Fax:
Practice Address - Street 1:773 W LINCOLN BLVD STE 201C
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:IL
Practice Address - Zip Code:61032-4978
Practice Address - Country:US
Practice Address - Phone:815-541-7173
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional