1588860662 NPI number — GERALD MATHIAS DASSINGER LICSW

Table of content: GERALD MATHIAS DASSINGER LICSW (NPI 1588860662)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588860662 NPI number — GERALD MATHIAS DASSINGER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DASSINGER
Provider First Name:
GERALD
Provider Middle Name:
MATHIAS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DASSINGER
Provider Other First Name:
GARY
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LICSW
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1588860662
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9911 45TH ST SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLADSTONE
Provider Business Mailing Address State Name:
ND
Provider Business Mailing Address Postal Code:
58630-9744
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
701-483-9911
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11 2ND AVE E
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
DICKINSON
Provider Business Practice Location Address State Name:
ND
Provider Business Practice Location Address Postal Code:
58601-5218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
701-483-9720
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  2235 , registered in the state of ND ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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