MEDICARE: JERRY GILLETTE MSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	6801034739	MI

General Provider Information

NPI Number	:	1831224682
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY GILLETTE MSW

Provider Business Mailing Address
First Line	:	140 MICHIGAN AVE W
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49017-3602
Country	:	US
Telephone Number	:	269-966-1460
Fax Number	:	269-966-2844

Provider Business Practice Location Address
First Line	:	391 S SHORE DR STE 214
Second Line	:
City	:	BATTLE CREEK
State	:	MI
Zip	:	49014-5446
Country	:	US
Telephone Number	:	269-964-0153
Fax Number	:	855-877-5812

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2007
Last Update Date	:	03/22/2024

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