Provider Demographics
NPI:1326227802
Name:GILLIS, TORRI JEAN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:TORRI
Middle Name:JEAN
Last Name:GILLIS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:TORRI
Other - Middle Name:JEAN
Other - Last Name:GILLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW, LCSW
Mailing Address - Street 1:504 LAKELAND ROAD
Mailing Address - Street 2:
Mailing Address - City:SHAWANO
Mailing Address - State:WI
Mailing Address - Zip Code:54166-6832
Mailing Address - Country:US
Mailing Address - Phone:715-526-4700
Mailing Address - Fax:715-526-5542
Practice Address - Street 1:504 LAKELAND ROAD
Practice Address - Street 2:
Practice Address - City:SHAWANO
Practice Address - State:WI
Practice Address - Zip Code:54166-6832
Practice Address - Country:US
Practice Address - Phone:715-526-4700
Practice Address - Fax:715-526-5542
Is Sole Proprietor?:No
Enumeration Date:2007-10-31
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI7683-1231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI40996700Medicaid
WI7683-123OtherLCSW
WI7683-123OtherLCSW