Provider Demographics
NPI:1902966518
Name:GILLETTE, JENNIFER GALE (LMSW, OSW-C)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:GALE
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:LMSW, OSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 SHADOW DR
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1779
Mailing Address - Country:US
Mailing Address - Phone:248-224-2930
Mailing Address - Fax:
Practice Address - Street 1:22301 FOSTER WINTER DR
Practice Address - Street 2:3RD FLOOR
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3707
Practice Address - Country:US
Practice Address - Phone:248-849-3243
Practice Address - Fax:248-849-2919
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010813931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical