Individual
NEAL ALLEN GILLETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
10520 WAYZATA BLVD, HOPKINS, MN 55305-1511
(612) 220-1151
(952) 681-2568
Mailing address
14024 ROYAL CT, MINNETONKA, MN 55345-3928
(952) 933-4085
(952) 417-2146
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
LP2348
MN
1041C0700X
Clinical Social Worker
8058
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4H5581GI 4H557GI LP
BLUE CROSS BLUE SHIELD
MN
01
—
673552500
MEDICAL ASSISTANCE
MN
Enumeration date
12/01/2006
Last updated
12/28/2011
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