Provider Demographics
NPI:1609049360
Name:GILLESPIE, JENNIFER (LMP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1555 ALPENSEE STRASSE
Mailing Address - Street 2:
Mailing Address - City:LEAVENWORTH
Mailing Address - State:WA
Mailing Address - Zip Code:98826-9308
Mailing Address - Country:US
Mailing Address - Phone:509-548-5238
Mailing Address - Fax:
Practice Address - Street 1:10090 MAIN STREET
Practice Address - Street 2:
Practice Address - City:PESHASTIN
Practice Address - State:WA
Practice Address - Zip Code:98847
Practice Address - Country:US
Practice Address - Phone:509-548-0784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00010813225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist