Provider Demographics
NPI:1033529938
Name:GILLETTE, MELISSA (PHD, MS, CGC)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:
Last Name:GILLETTE
Suffix:
Gender:F
Credentials:PHD, MS, CGC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 W WALNUT ST # IB130
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-5181
Mailing Address - Country:US
Mailing Address - Phone:317-944-3966
Mailing Address - Fax:317-968-1354
Practice Address - Street 1:975 W WALNUT ST # IB130
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5181
Practice Address - Country:US
Practice Address - Phone:317-944-3966
Practice Address - Fax:317-968-1354
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
170300000X
IN74000032A170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS