Provider Demographics
NPI:1356360036
Name:GILLESPIE, ROBERT ANDREW (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANDREW
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 ROCKFERN DR
Mailing Address - Street 2:
Mailing Address - City:HIGH RIDGE
Mailing Address - State:MO
Mailing Address - Zip Code:63049-1445
Mailing Address - Country:US
Mailing Address - Phone:610-996-1200
Mailing Address - Fax:314-881-4221
Practice Address - Street 1:14561 N OUTER 40
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5703
Practice Address - Country:US
Practice Address - Phone:314-881-4245
Practice Address - Fax:314-881-4221
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-19
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS015565103TC0700X
CAPSY18710103TC0700X
WI1866-057103TC0700X
FLPY3870103TC0700X
MNLP1049103TC0700X
MO2007006356103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL187100Medicare ID - Type UnspecifiedMEDICARE PROVIDER #
R48941Medicare UPIN
WI000084683Medicare ID - Type UnspecifiedWI MEDICARE PROVIDER#
PA107375V3AMedicare PIN