Provider Demographics
NPI:1669833141
Name:GILLESPIE, MEGHAN (MS, LCGC)
Entity Type:Individual
Prefix:MS
First Name:MEGHAN
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MS, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 HAMILTON WAY
Mailing Address - Street 2:APT A
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-2107
Mailing Address - Country:US
Mailing Address - Phone:323-313-8887
Mailing Address - Fax:
Practice Address - Street 1:11915 LA GRANGE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5213
Practice Address - Country:US
Practice Address - Phone:877-743-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-11
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000350170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS