1942369061 NPI number — LAWREN PEGGY GLADEN LCSW, PLLC

Table of content: LAWREN PEGGY GLADEN LCSW, PLLC (NPI 1942369061)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942369061 NPI number — LAWREN PEGGY GLADEN LCSW, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLADEN
Provider First Name:
LAWREN
Provider Middle Name:
PEGGY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW, PLLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHALMERS-GLADEN
Provider Other First Name:
LAWREN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1942369061
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
725 WEST ALDER ROAD
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
MISSOULA
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59802-4036
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-546-4690
Provider Business Mailing Address Fax Number:
406-543-0282

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
725 W ALDER ST
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
MISSOULA
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59802-4036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-546-4690
Provider Business Practice Location Address Fax Number:
406-273-0692
Provider Enumeration Date:
12/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  722 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com