Individual
MARY KATHLEEN GIESBRECHT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP
Contact information
Practice address
102 LAKE VIEW CT, KINGSLAND, GA 31548-7809
(912) 617-1037
(912) 576-2708
Mailing address
102 LAKE VIEW CT, KINGSLAND, GA 31548-7809
(912) 617-1037
(912) 576-2708
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
SLP005854
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
524841136A
—
GA
05
—
524841136C
—
GA
Enumeration date
07/07/2005
Last updated
07/21/2022
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