Provider Demographics
NPI:1750429254
Name:GILLETTE, PATRICIA ANNE (LPC AND LMFT)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANNE
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:LPC AND LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3777 BOHNSACK LN
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:WI
Mailing Address - Zip Code:53527-9567
Mailing Address - Country:US
Mailing Address - Phone:608-839-3270
Mailing Address - Fax:
Practice Address - Street 1:310 NORTH MIDVALE BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53527
Practice Address - Country:US
Practice Address - Phone:608-819-7513
Practice Address - Fax:608-238-1929
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1133125101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43594900Medicaid