MEDICARE: KYRA GILLESPIE

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1598326050
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYRA GILLESPIE

Provider Business Mailing Address
First Line	:	12729 NORTHUP WAY STE 23
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-1935
Country	:	US
Telephone Number	:	866-727-8274
Fax Number	:

Provider Business Practice Location Address
First Line	:	12729 NORTHUP WAY STE 23
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98005-1935
Country	:	US
Telephone Number	:	866-727-8274
Fax Number	:

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	03/19/2021

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Directions to “ KYRA GILLESPIE ” Practice Location

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