Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 2243184-73 | IL |
NPI | 1013148162 |
---|---|
Provider Name | Mr. Michael Jason Gladstein |
First Address | Northfield, IL 60093-3021 |
Second Address | Northfield, IL 60093-3021 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/08/2009 |
Last Update Date | 06/08/2009 |