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General NPI Number Information
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NPI Number | 1902966518
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Entity Type | Individual
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Provider Name | JENNIFER GALE GILLETTE LMSW, OSW-C
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Gender | Female
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Dates
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Enumeration Date | 12/12/2006
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Last Update Date | 09/18/2023
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Provider Practice Location Address
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Address Line | 22301 FOSTER WINTER DR 3RD FLOOR
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City | SOUTHFIELD
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State | MI
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Zip | 48075-3707
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Country | US
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Telephone | 248-849-3243
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Fax | 248-849-2919
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Provider Business Mailing Address
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Address Line | 1157 SHADOW DR
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City | TROY
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State | MI
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Zip | 48085-1779
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Country | US
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Telephone | 248-224-2930
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 6801081393
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License Number State | MI
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