Individual provider Active NPI

William Matt Gillispie, CCC-SPL

  • Speech-Language Pathologist
  • Lawrence, KS
National Provider Identifier
1609914720
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
02157 Issued in KS
Practice address
1200 Sunnyside Ave.
2101 Haworth Hall
Lawrence, KS 66045-0667
Phone
(785) 864-4690
Fax
(785) 864-5094
NPI assigned
Feb 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 02157 KS Primary

Addresses

Primary practice location

1200 Sunnyside Ave.
2101 Haworth Hall
Lawrence, KS 66045-0667

Mailing address

1200 Sunnyside Ave.
2101 Haworth Hall
Lawrence, KS 66045-0667
Phone (785) 864-4690

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in KS

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161103001993 KS Practitioner - Qualified Speech Language Pathologist 1153609623 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
02157KSMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
Watkins Health Services- the Univ of Kansas - Watkins Health Services Current Accepting new patients
University of Kansas Speech-Language Pathologist CurrentSince Jan 1, 2021 Accepting new patients

Locations

1200 Sunnyside Ave
#2101
Lawrence, KS 66045
Phone (785) 864-0656

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170288000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1609914720",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1200 SUNNYSIDE AVE.",
            "address_2": "2101 HAWORTH HALL",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660450667",
            "telephone_number": "785-864-4690",
            "fax_number": "785-864-5094"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1200 SUNNYSIDE AVE.",
            "address_2": "2101 HAWORTH HALL",
            "city": "LAWRENCE",
            "state": "KS",
            "postal_code": "660450667",
            "telephone_number": "785-864-4690",
            "fax_number": "785-864-5094"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GILLISPIE",
        "first_name": "WILLIAM",
        "middle_name": "MATT",
        "credential": "CCC-SPL",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-02-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "KS",
            "license": "02157",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lawrence, KS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.