Provider Demographics
NPI:1144735465
Name:GILLESPIE-JENSEN, KATHLEEN LYNN (MA, MS, TLMHC)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:LYNN
Last Name:GILLESPIE-JENSEN
Suffix:
Gender:F
Credentials:MA, MS, TLMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 N CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SHENANDOAH
Mailing Address - State:IA
Mailing Address - Zip Code:51601-1322
Mailing Address - Country:US
Mailing Address - Phone:712-209-0848
Mailing Address - Fax:
Practice Address - Street 1:215 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:CLARINDA
Practice Address - State:IA
Practice Address - Zip Code:51632-1625
Practice Address - Country:US
Practice Address - Phone:712-542-3501
Practice Address - Fax:712-542-4725
Is Sole Proprietor?:No
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA089612101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health