Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 26687 | CA |
N | 1041C0700X | Clinical Social Worker | 26687 | CA |
NPI | 1003141458 |
---|---|
Provider Name | Suzanne Jane Glidewell |
First Address | Sacramento, CA 95826-2563 |
Second Address | Sacramento, CA 95826-2563 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/10/2009 |
Last Update Date | 09/03/2012 |