Active NPI
Susan M Gillespie, MS LP
- Clinical Psychologist
- Virginia, MN
National Provider Identifier
1992806384
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- LP2347
- Practice address
- 624 S 13TH St
Range Mental Health Center Inc
Virginia, MN 55792 - Phone
- (218) 749-2881
- Fax
- (218) 749-3806
- NPI assigned
- Sep 26, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | LP2347 | MN | Primary |
Addresses
Primary practice location
624 S 13TH St
Range Mental Health Center Inc
Virginia, MN 55792
Mailing address
624 S 13TH St
Range Mental Health Center Inc
Virginia, MN 55792
Phone (218) 749-2881
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LP2347 | MN | MD | Clinical Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159228800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992806384",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "624 S 13TH ST",
"address_2": "RANGE MENTAL HEALTH CENTER INC",
"city": "VIRGINIA",
"state": "MN",
"postal_code": "55792",
"telephone_number": "218-749-2881",
"fax_number": "218-749-3806"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "624 S 13TH ST",
"address_2": "RANGE MENTAL HEALTH CENTER INC",
"city": "VIRGINIA",
"state": "MN",
"postal_code": "55792",
"telephone_number": "218-749-2881",
"fax_number": "218-749-3806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLESPIE",
"first_name": "SUSAN",
"middle_name": "M",
"credential": "MS LP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-09-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "MN",
"license": "LP2347",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia, MN
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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.