Provider Demographics
NPI:1316148281
Name:GILLESPIE, KATIE J (MA, ATR-BC, LPC)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:J
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MA, ATR-BC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 YELLOW SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-8763
Mailing Address - Country:US
Mailing Address - Phone:610-308-9200
Mailing Address - Fax:
Practice Address - Street 1:2272 YELLOW SPRINGS RD
Practice Address - Street 2:
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-8763
Practice Address - Country:US
Practice Address - Phone:610-308-9200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004571101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional