MEDICARE: LAURIE ANN GILLESPIE MSS, LCSW

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	104100000X	Social Worker	SW123303	PA
2	1041S0200X	School Social Worker	ED HM SCHOOL VISITOR	PA
3	1041C0700X	Clinical Social Worker	CW123303	PA

General Provider Information

NPI Number	:	1174580609
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURIE ANN GILLESPIE MSS, LCSW

Provider Business Mailing Address
First Line	:	8226 ARDLEIGH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3414
Country	:	US
Telephone Number	:	610-547-7174
Fax Number	:

Provider Business Practice Location Address
First Line	:	8226 ARDLEIGH ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19118-3414
Country	:	US
Telephone Number	:	610-547-7174
Fax Number	:

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

Provider Enumeration Date	:	04/27/2006
Last Update Date	:	09/11/2025

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