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General NPI Number Information
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NPI Number | 1699811752
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Entity Type | Organization
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Legal Business Name | PENNY GIESBRECHT, PSYD LP PA
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Dates
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Enumeration Date | 01/29/2007
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Last Update Date | 10/25/2024
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Provider Practice Location Address
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Address Line | 521 TANGLEWOOD DR
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City | SHOREVIEW
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State | MN
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Zip | 55126-2016
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Country | US
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Telephone | 651-486-0122
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Fax | 651-481-8661
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Provider Business Mailing Address
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Address Line | 521 TANGLEWOOD DR
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City | SHOREVIEW
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State | MN
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Zip | 55126-2016
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Country | US
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Telephone | 651-486-0122
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Fax | 651-481-8661
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Authorized Official
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Title or Position | L.P.
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Name | DR. PENNY SUE GIESBRECHT
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Credential | PSY.D.
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Telephone | 651-485-2842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP3788
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License Number State | MN
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