Provider Demographics
NPI:1588468391
Name:GILLESPIE, CHASITY DESIREE
Entity type:Individual
Prefix:
First Name:CHASITY
Middle Name:DESIREE
Last Name:GILLESPIE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 SIAMESE LN
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:WV
Mailing Address - Zip Code:25124-7245
Mailing Address - Country:US
Mailing Address - Phone:304-610-7359
Mailing Address - Fax:
Practice Address - Street 1:33 SIAMESE LN
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:WV
Practice Address - Zip Code:25124-7245
Practice Address - Country:US
Practice Address - Phone:304-610-7359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-02
Last Update Date:2025-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency