Mary Kathleen Giesbrecht, SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

SLP005854 Issued in GA

Practice address

102 Lake View CT
Kingsland, GA 31548-7809

Phone

(912) 617-1037

Fax

(912) 576-2708

NPI assigned

Jul 7, 2005

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Advance for Kids Inc

  • Physical Therapist
  • Saint Marys, GA
  • NPI 1700075124

  Speech-Language Pathologist

  NPD (past)
• Advance Rehabilitation and Consulting

  • Physical Therapist
  • Rome, GA
  • NPI 1174518682

  Speech-Language Pathologist

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1326045006",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 LAKE VIEW CT",
            "city": "KINGSLAND",
            "state": "GA",
            "postal_code": "315487809",
            "telephone_number": "912-617-1037",
            "fax_number": "912-576-2708"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 LAKE VIEW CT",
            "city": "KINGSLAND",
            "state": "GA",
            "postal_code": "315487809",
            "telephone_number": "912-617-1037",
            "fax_number": "912-576-2708"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Turner McCall Blvd NW",
            "address_purpose": "LOCATION",
            "city": "Rome",
            "state": "GA",
            "postal_code": "301652545",
            "country_code": "US",
            "telephone_number": "706-236-2758",
            "fax_number": "706-802-1408",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "GIESBRECHT",
        "first_name": "MARY",
        "middle_name": "KATHLEEN",
        "credential": "SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "SLP005854",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "524841136C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "524841136A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gateway Behavioral Health Services
• Lisa Leanne Gentzler, M.P.T.
• Georgia CVS Pharmacy LLC (CVS Pharmacy #05737)
• Georgia Pain Physicians PC
• Georgia Psychiatry Services LLC
• GLL Center, LLC
• Golden Isles Pediatric Dentistry
• Kimberly Michelle Gomez, MSN, APRN, FNP-C
• Samantha Graf
• Kimberly H Graw, APRN, BC, FNP

• Speech-Language Pathologist in Kingsland, GA
• Providers in Kingsland, GA by specialty
• Speech-Language Pathologist in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.