Provider Demographics
NPI:1629623798
Name:GILLESPIE, AMBER LEIGH
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:LEIGH
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2923 DOUGLAS DR
Mailing Address - Street 2:
Mailing Address - City:BAY CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48706-1221
Mailing Address - Country:US
Mailing Address - Phone:989-588-1302
Mailing Address - Fax:
Practice Address - Street 1:2923 DOUGLAS DR
Practice Address - Street 2:
Practice Address - City:BAY CITY
Practice Address - State:MI
Practice Address - Zip Code:48706-1221
Practice Address - Country:US
Practice Address - Phone:989-588-1302
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-06
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician