Individual
MRS. MISTY DAWN GILLETTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BA, CADC
Contact information
Practice address
310 W. MAIN ST, OTTUMWA, IA 52501
(641) 683-6747
(641) 683-6317
Mailing address
P.O. BOX 658, OTTUMWA, IA 52501
(641) 683-6747
(641) 683-6317
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
16187
IA
Other
Enumeration date
05/12/2017
Last updated
05/12/2017
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