Provider Demographics
NPI:1770227332
Name:GIESE, MADISON KATE
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:KATE
Last Name:GIESE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BAIRDS LN
Mailing Address - Street 2:
Mailing Address - City:BURLESON
Mailing Address - State:TX
Mailing Address - Zip Code:76028-2418
Mailing Address - Country:US
Mailing Address - Phone:817-995-2677
Mailing Address - Fax:
Practice Address - Street 1:1111 SUMMIT AVE
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76102-3425
Practice Address - Country:US
Practice Address - Phone:817-877-1199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist