Provider Demographics
NPI:1205631587
Name:GILLETTE, VINCENT
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:THREE RIVERS HUMAN SERVICE ZONE
Mailing Address - Street 2:210 2ND AVE NW
Mailing Address - City:MANDAN
Mailing Address - State:ND
Mailing Address - Zip Code:58554
Mailing Address - Country:US
Mailing Address - Phone:701-667-3395
Mailing Address - Fax:701-667-3384
Practice Address - Street 1:THREE RIVERS HUMAN SERVICE ZONE
Practice Address - Street 2:210 2ND AVE NW
Practice Address - City:MANDAN
Practice Address - State:ND
Practice Address - Zip Code:58554
Practice Address - Country:US
Practice Address - Phone:701-667-3395
Practice Address - Fax:701-667-3384
Is Sole Proprietor?:No
Enumeration Date:2025-02-19
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator