Healthcare Provider Details

I. General information

NPI: 1932791548
Provider Name (Legal Business Name): SARAH J GILLETT LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/04/2021
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1635 S RUSSELL ST
MISSOULA MT
59801-5636
US

IV. Provider business mailing address

2311 HIGHWOOD DR
MISSOULA MT
59803-2129
US

V. Phone/Fax

Practice location:
  • Phone: 406-203-9948
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number48222
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: