Healthcare Provider Details

I. General information

NPI: 1780376145
Provider Name (Legal Business Name): CHLOE GILMORE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2023
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 COMMERCE DR
WYOMISSING PA
19610-3335
US

IV. Provider business mailing address

640 FREEDOM BUSINESS CTR DR STE 220
KING OF PRUSSIA PA
19406-1376
US

V. Phone/Fax

Practice location:
  • Phone: 484-965-9966
  • Fax: 484-231-8631
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBH008712
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: