1235420811 NPI number — MS. SUSAN GENTZ GILLESPIE MFT

Table of content: MS. SUSAN GENTZ GILLESPIE MFT (NPI 1235420811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235420811 NPI number — MS. SUSAN GENTZ GILLESPIE MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GILLESPIE
Provider First Name:
SUSAN
Provider Middle Name:
GENTZ
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GENTZ
Provider Other First Name:
SUSAN
Provider Other Middle Name:
LAURA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
MFT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1235420811
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 CONNECTICUT AVE NW
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20036-2603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-609-8205
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 CONNECTICUT AVE NW
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20036-2603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-609-8205
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/29/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MFC 38572 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: 000140 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)