Provider Demographics
NPI:1699591263
Name:GILLESPIE, CLINTRELL
Entity type:Individual
Prefix:
First Name:CLINTRELL
Middle Name:
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 1:3730 LYONS AVE APT 209
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77020-8362
Mailing Address - Country:US
Mailing Address - Phone:832-884-6520
Mailing Address - Fax:
Practice Address - Street 1:3730 LYONS AVE APT 209
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77020-8362
Practice Address - Country:US
Practice Address - Phone:832-884-6520
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-28
Last Update Date:2024-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty