Individual
JAURDYN LEEANNE GILLISS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2900 5TH ST S, MOORHEAD, MN 56560-4966
(701) 306-5986
Mailing address
2900 5TH ST S, MOORHEAD, MN 56560-4966
(701) 306-5986
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
MN
Other
Enumeration date
06/21/2022
Last updated
06/21/2022
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