Provider Demographics
NPI:1538922240
Name:GILLETT, AMBER B (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:B
Last Name:GILLETT
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:B
Other - Last Name:NIELSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 3RD ST NE
Mailing Address - Street 2:
Mailing Address - City:AITKIN
Mailing Address - State:MN
Mailing Address - Zip Code:56431-1421
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13 3RD ST NE
Practice Address - Street 2:
Practice Address - City:AITKIN
Practice Address - State:MN
Practice Address - Zip Code:56431-1421
Practice Address - Country:US
Practice Address - Phone:612-643-1951
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-05
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN286771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical