Provider Demographics
NPI:1154443653
Name:GILLETTE, PATRICIA J (MA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:J
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 MERRILL AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-3429
Mailing Address - Country:US
Mailing Address - Phone:715-675-3888
Mailing Address - Fax:715-675-2988
Practice Address - Street 1:1720 MERRILL AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:WAUSAU
Practice Address - State:WI
Practice Address - Zip Code:54401-3429
Practice Address - Country:US
Practice Address - Phone:715-675-3888
Practice Address - Fax:715-675-2988
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1040-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional