Provider Demographics
NPI:1255928941
Name:GILLESPIE, DESIREE ELISE (CRC)
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:ELISE
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9364 WALLINGFORD DR
Mailing Address - Street 2:
Mailing Address - City:TWINSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44087-3248
Mailing Address - Country:US
Mailing Address - Phone:216-337-1041
Mailing Address - Fax:
Practice Address - Street 1:9364 WALLINGFORD DR
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-3248
Practice Address - Country:US
Practice Address - Phone:216-337-1041
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-29
Last Update Date:2020-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH00095068225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner