Individual
MRS. MARY LEIGH KIRSCHBAUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.S./CCC-SLP
Contact information
Practice address
410 ROEDL COURT, GOLDEN LIVING CENTER, BEAVER DAM, WI 53916
(920) 887-7191
(920) 887-7270
Mailing address
205 PRAIRIE VIEW DR, BEAVER DAM, WI 53916-3406
(920) 296-4889
(920) 356-0621
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
89-154
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
41220500
—
WI
Enumeration date
04/11/2008
Last updated
04/11/2008
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