Provider Demographics
NPI:1033529938
Name:GILLETTE, MELISSA (PHD, LCGC)
Entity Type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:PHD, LCGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E DOUGLAS RD
Mailing Address - Street 2:STE. 408
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46545-1464
Mailing Address - Country:US
Mailing Address - Phone:574-335-6440
Mailing Address - Fax:574-335-0806
Practice Address - Street 1:611 E DOUGLAS RD
Practice Address - Street 2:STE. 408
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46545-1468
Practice Address - Country:US
Practice Address - Phone:574-335-6440
Practice Address - Fax:574-335-0806
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2018-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
IN74000032A170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS