Individual
DR. ANGELIQUE GILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
Mailing address
927 TRETTEL LN, CLOQUET, MN 55720-1345
(218) 879-1227
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
071817
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
08/06/2014
Last updated
11/09/2017
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