MEDICARE: MS. MICHELLE DAWN GILLESPIE MA CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	016365-1	NY

General Provider Information

NPI Number	:	1598959686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MICHELLE DAWN GILLESPIE MA CCC-SLP

Provider Business Mailing Address
First Line	:	1 E BROADWAY
Second Line	:	APT 2K
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4113
Country	:	US
Telephone Number	:	516-665-3020
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 E BROADWAY
Second Line	:	APT 2K
City	:	LONG BEACH
State	:	NY
Zip	:	11561-4113
Country	:	US
Telephone Number	:	516-665-3020
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/31/2007
Last Update Date	:	08/31/2007

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