Provider Demographics
NPI:1912763962
Name:GILLESPIE, MCKENZIE D (CPC, CHW,)
Entity Type:Individual
Prefix:
First Name:MCKENZIE
Middle Name:D
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:CPC, CHW,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-2828
Mailing Address - Country:US
Mailing Address - Phone:509-853-0765
Mailing Address - Fax:
Practice Address - Street 1:124 S 3RD ST
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-2828
Practice Address - Country:US
Practice Address - Phone:509-571-0998
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-27
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACG61530691175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist