Provider Demographics
NPI:1609914720
Name:GILLISPIE, WILLIAM MATT (CCC-SPL)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MATT
Last Name:GILLISPIE
Suffix:
Gender:M
Credentials:CCC-SPL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SUNNYSIDE AVE.
Mailing Address - Street 2:2101 HAWORTH HALL
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66045-0667
Mailing Address - Country:US
Mailing Address - Phone:785-864-4690
Mailing Address - Fax:785-864-5094
Practice Address - Street 1:1200 SUNNYSIDE AVE.
Practice Address - Street 2:2101 HAWORTH HALL
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66045-0667
Practice Address - Country:US
Practice Address - Phone:785-864-4690
Practice Address - Fax:785-864-5094
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS02157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist