Provider Demographics
NPI:1649881780
Name:WITHERS, GILLIAN (MS)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:WITHERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8126 CARRIAGE BEND LN
Mailing Address - Street 2:
Mailing Address - City:HENRICO
Mailing Address - State:VA
Mailing Address - Zip Code:23294-4352
Mailing Address - Country:US
Mailing Address - Phone:804-396-9484
Mailing Address - Fax:
Practice Address - Street 1:1801 LAUDERDALE DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-4009
Practice Address - Country:US
Practice Address - Phone:804-750-2640
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist