Provider Demographics
NPI:1962617902
Name:GILLESPIE, DEBORAH LYN (IBCLC, RLC)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LYN
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:IBCLC, RLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1502 E HERMOSA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85282-5722
Mailing Address - Country:US
Mailing Address - Phone:480-786-0431
Mailing Address - Fax:480-745-3615
Practice Address - Street 1:3355 W CHANDLER BLVD
Practice Address - Street 2:SUITE 3
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-5096
Practice Address - Country:US
Practice Address - Phone:480-786-0431
Practice Address - Fax:480-745-3615
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-12
Last Update Date:2012-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ105-22185174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN