Provider Demographics
NPI:1285857920
Name:GILLESPIE, YVONNE (LMSW, ACSW)
Entity type:Individual
Prefix:MRS
First Name:YVONNE
Middle Name:
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16386 EDWARDS AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48076-5805
Mailing Address - Country:US
Mailing Address - Phone:313-587-9445
Mailing Address - Fax:248-569-0221
Practice Address - Street 1:28220 FRANKLIN RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1659
Practice Address - Country:US
Practice Address - Phone:313-587-9445
Practice Address - Fax:248-569-0221
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010609011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI208049OtherVALUE OPTIONS
VA2053095OtherCIGNA BEHAVIORAL HEALTH
PA60054OtherAETNA
MA620356OtherPPOM