Provider Demographics
NPI:1871517243
Name:GILLESPIE, ROBERT JOSEPH (PHD, LMFT, LPC)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:GILLESPIE
Suffix:
Gender:M
Credentials:PHD, LMFT, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1619 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53711-2063
Mailing Address - Country:US
Mailing Address - Phone:608-255-9330
Mailing Address - Fax:608-255-7810
Practice Address - Street 1:1619 MONROE ST
Practice Address - Street 2:INTEGRAL PSYCHOLOGY CENTER
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53711-2063
Practice Address - Country:US
Practice Address - Phone:608-255-9330
Practice Address - Fax:608-255-7810
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2023-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6390101YM0800X
WI4633-125101YP2500X
PAMF000622106H00000X
NJ37FI00162200106H00000X
WI880-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1871517243Medicaid