| Doctor Name: | MR. MICHAEL JASON GLADSTEIN |
| NPI Number: | 1013148162 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | ED.S. |
| License Number: | 2243184-73 |
| Business Practice Address: | 1780 Maple St Ste 1 Northfield, IL - 600933021 |
| Business Phone Number: | 8476448005 |
| Business Fax Number: | |
| Mailing Address: | 1780 Maple St Ste 1, NORTHFIELD |
| State: | IL |
| Postal Code: | 600933021 |
| Phone Number: | 8476448005 |
| Fax Number: | |
| NPI Enumeration Date: | 08/06/2009 |
| NPI Last Update Date: | 08/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TS0200X |
| License Number: | 2243184-73 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | School |
| Taxonomy Definition: | |