Provider Demographics
NPI:1396830758
Name:GIESBRECHT, PENNY SUE (PSYD, LP)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:SUE
Last Name:GIESBRECHT
Suffix:
Gender:F
Credentials:PSYD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 HARRIET CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126
Mailing Address - Country:US
Mailing Address - Phone:651-486-0122
Mailing Address - Fax:651-481-8661
Practice Address - Street 1:521 TANGLEWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126
Practice Address - Country:US
Practice Address - Phone:651-486-0122
Practice Address - Fax:651-481-8661
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN50Q60GIOtherBCBS
MN792462Other792462
MN925015800Medicaid
MN57730OtherHEALTH PARTNERS
MN115244OtherUCARE
MN792462Other792462
MN50Q60GIOtherBCBS