Provider Demographics
NPI:1134722440
Name:GILLES, BRITTANY (CAPSW)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:
Last Name:GILLES
Suffix:
Gender:F
Credentials:CAPSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LAKEWOOD GARDENS LN
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53704-4613
Mailing Address - Country:US
Mailing Address - Phone:920-515-5455
Mailing Address - Fax:
Practice Address - Street 1:1202 NORTHPORT DR
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53704-2020
Practice Address - Country:US
Practice Address - Phone:608-283-1364
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132030121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI132030121OtherWI DSPS LICENSE NUMBER