Provider Demographics
NPI:1598959686
Name:GILLESPIE, MICHELLE DAWN (MA CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:DAWN
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 E BROADWAY
Mailing Address - Street 2:APT 2K
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-4113
Mailing Address - Country:US
Mailing Address - Phone:516-665-3020
Mailing Address - Fax:
Practice Address - Street 1:1 E BROADWAY
Practice Address - Street 2:APT 2K
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-4113
Practice Address - Country:US
Practice Address - Phone:516-665-3020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016365-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist