Provider Demographics
NPI:1336555077
Name:GILLILAND, KATIE (MSED)
Entity Type:Individual
Prefix:MISS
First Name:KATIE
Middle Name:
Last Name:GILLILAND
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3343 CRESCENT ST APT 6A
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-3835
Mailing Address - Country:US
Mailing Address - Phone:718-986-6895
Mailing Address - Fax:
Practice Address - Street 1:460 WEST 34TH STREET 11TH FLOOR
Practice Address - Street 2:YAI LIFESTART
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:646-291-8386
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-02
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1276273174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist