Provider Demographics
NPI:1104095835
Name:GILLIARD, JENNIFER (PHD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:
Last Name:GILLIARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W GRANITE ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-9215
Mailing Address - Country:US
Mailing Address - Phone:406-723-5403
Mailing Address - Fax:
Practice Address - Street 1:125 W GRANITE ST
Practice Address - Street 2:SUITE 208
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-9215
Practice Address - Country:US
Practice Address - Phone:406-782-2393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-27
Last Update Date:2008-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT550101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional