Provider Demographics
NPI:1023236486
Name:GILLARD, LYNETTE H (GSW)
Entity type:Individual
Prefix:MS
First Name:LYNETTE
Middle Name:H
Last Name:GILLARD
Suffix:
Gender:F
Credentials:GSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7260 READ BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70127-2226
Mailing Address - Country:US
Mailing Address - Phone:504-220-9131
Mailing Address - Fax:
Practice Address - Street 1:7260 READ BLVD
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70127-2226
Practice Address - Country:US
Practice Address - Phone:504-220-9131
Practice Address - Fax:832-446-6792
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2020-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA7710171M00000X, 171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor
No171M00000XOther Service ProvidersCase Manager/Care Coordinator