Healthcare Provider Details

I. General information

NPI: 1124983697
Provider Name (Legal Business Name): KATIE GILLESPIE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

89 MAIN ST
MIDDLEBURY VT
05753-1483
US

IV. Provider business mailing address

89 MAIN ST
MIDDLEBURY VT
05753-1483
US

V. Phone/Fax

Practice location:
  • Phone: 802-388-6751
  • Fax: 802-388-8183
Mailing address:
  • Phone: 802-388-6751
  • Fax: 802-388-8183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number068.0136978
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: