Stacey Nicole Gillette | Farmington, MO • PECOS Search

Stacey Nicole Gillette

Social Worker

Behavioral Health & Social Service Providers

17885 Hart Pinkston Rd, Farmington, MO 63640

PECOS Enrollment

Based on the most recent information from CMS, provider Stacey Nicole Gillette does not have current enrollment records in PECOS.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Not Enrolled
PMD
Power Mobility Device
Not Enrolled

CMS last updated its PECOS records 33 days ago.

Profile Details

Provider ID
1619519089
Provider Type
Individual
Full Name
Gillette, Stacey Nicole
Title
Mrs.
Credential
LCSW

Gender
Female
Sole Proprietor
Yes
Enumeration Date
10/17/2019
Last Updated
4/30/2022

Contact Information

Practice Location

17885 Hart Pinkston Rd, Farmington, MO 63640

Unlisted Fax

Mailing Location

17885 Hart Pinkston Rd, Farmington, MO 63640

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 1041C0700X Primary	Description Social Worker Behavioral Health & Social Service Providers	License 2019022665 Missouri