Provider Demographics
NPI:1841517588
Name:GILLESPIE, KELLY I
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:I
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 WASHINGTON ST
Mailing Address - Street 2:UNIT 2E
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01832-5738
Mailing Address - Country:US
Mailing Address - Phone:978-373-2625
Mailing Address - Fax:
Practice Address - Street 1:57 WASHINGTON ST
Practice Address - Street 2:UNIT 2E
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01832-5738
Practice Address - Country:US
Practice Address - Phone:978-373-2625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-20
Last Update Date:2010-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6340235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist