Provider Demographics
NPI:1699811752
Name:PENNY GIESBRECHT, PSYD LP PA
Entity Type:Organization
Organization Name:PENNY GIESBRECHT, PSYD LP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:L.P.
Authorized Official - Prefix:DR
Authorized Official - First Name:PENNY
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:GIESBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:651-483-6389
Mailing Address - Street 1:521 TANGLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SHOREVIEW
Mailing Address - State:MN
Mailing Address - Zip Code:55126-2016
Mailing Address - Country:US
Mailing Address - Phone:651-486-0122
Mailing Address - Fax:651-481-8661
Practice Address - Street 1:521 TANGLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SHOREVIEW
Practice Address - State:MN
Practice Address - Zip Code:55126-2016
Practice Address - Country:US
Practice Address - Phone:651-486-0122
Practice Address - Fax:651-481-8661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-29
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP3788103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6191037OtherUBH
MN50Q60GIOtherBCBS
MN2103601OtherBHP
MN925015800Medicaid
MN2103601OtherBHP
MNC03953Medicare PIN