Provider Demographics
NPI:1972837375
Name:GILLETTE, HEATHER TOPHAM (CPCI)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:TOPHAM
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1141 E 3900 S STE A170
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1250
Mailing Address - Country:US
Mailing Address - Phone:801-284-4900
Mailing Address - Fax:
Practice Address - Street 1:1141 E 3900 S STE A170
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1250
Practice Address - Country:US
Practice Address - Phone:801-284-4900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT67794386009101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor