MEDICARE: MADISON GIESTING

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	COND.20191143-SP	OH
2	235Z00000X	Speech-Language Pathologist	264513	KY

General Provider Information

NPI Number	:	1487200507
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADISON GIESTING

Provider Business Mailing Address
First Line	:	3942 FOREST AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3931
Country	:	US
Telephone Number	:	812-212-2425
Fax Number	:

Provider Business Practice Location Address
First Line	:	3942 FOREST AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-3931
Country	:	US
Telephone Number	:	812-212-2425
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2019
Last Update Date	:	01/14/2021

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Directions to “ MADISON GIESTING ” Practice Location

Language	Start Address	Practice Location

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