Provider Demographics
NPI:1962702332
Name:GILLESPIE, KRISTIE LYNN (MACCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KRISTIE
Middle Name:LYNN
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 IMPALA RD
Mailing Address - Street 2:
Mailing Address - City:GILBERTSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42044-9336
Mailing Address - Country:US
Mailing Address - Phone:314-603-2524
Mailing Address - Fax:
Practice Address - Street 1:515 IMPALA RD
Practice Address - Street 2:
Practice Address - City:GILBERTSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42044-9336
Practice Address - Country:US
Practice Address - Phone:314-603-2524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-01
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY-3583235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist