Provider Demographics
NPI:1649881780
Name:WITHERS, GILLIAN (MS)
Entity type:Individual
Prefix:
First Name:GILLIAN
Middle Name:
Last Name:WITHERS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 FORT HILL DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-3701
Mailing Address - Country:US
Mailing Address - Phone:804-396-9484
Mailing Address - Fax:
Practice Address - Street 1:4840 WALLER RD STE 200
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23230-2912
Practice Address - Country:US
Practice Address - Phone:804-893-5010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-12
Last Update Date:2025-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202010115235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist