Provider Demographics
NPI:1558247163
Name:GILLESPIE, COURTENAY CHAREICE (PA-S)
Entity type:Individual
Prefix:
First Name:COURTENAY
Middle Name:CHAREICE
Last Name:GILLESPIE
Suffix:
Gender:F
Credentials:PA-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5741 ERIE AVE
Mailing Address - Street 2:
Mailing Address - City:HAMMOND
Mailing Address - State:IN
Mailing Address - Zip Code:46320-2307
Mailing Address - Country:US
Mailing Address - Phone:312-863-0352
Mailing Address - Fax:
Practice Address - Street 1:2718 W ROSCOE ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5910
Practice Address - Country:US
Practice Address - Phone:773-961-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-12
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program