Mary Leigh Kirschbaum, M.S./CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

89-154 Issued in WI

Practice address

410 Roedl Court
Golden Living Center
Beaver Dam, WI 53916

Phone

(920) 887-7191

Fax

(920) 887-7270

NPI assigned

Apr 11, 2008

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1207872000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207872000000",
    "number": "1487827382",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 PRAIRIE VIEW DR",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "539163406",
            "telephone_number": "920-296-4889",
            "fax_number": "920-356-0621"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "410 ROEDL COURT",
            "address_2": "GOLDEN LIVING CENTER",
            "city": "BEAVER DAM",
            "state": "WI",
            "postal_code": "53916",
            "telephone_number": "920-887-7191",
            "fax_number": "920-887-7270"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KIRSCHBAUM",
        "first_name": "MARY",
        "middle_name": "LEIGH",
        "name_prefix": "Mrs.",
        "credential": "M.S./CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2008-04-11",
        "last_updated": "2008-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "89-154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "41220500",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speech-Language Pathologist in Beaver Dam, WI
• Providers in Beaver Dam, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2008; 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.