Doctor Name: | MS. GLADYS SHADE |
NPI Number: | 1114137494 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | QMHP, LCSW |
License Number: | 3124 |
Business Practice Address: | 1890 Waite St Suite 1 North Bend, OR - 974591229 |
Business Phone Number: | 5417566232 |
Business Fax Number: | 5417566234 |
Mailing Address: | 1890 Waite St, Suite 1 NORTH BEND |
State: | OR |
Postal Code: | 974591229 |
Phone Number: | 5417566232 |
Fax Number: | 5417566234 |
NPI Enumeration Date: | 05/23/2007 |
NPI Last Update Date: | 12/02/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 1041C0700X |
License Number: | 3124 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OR |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Social Worker |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: | A social worker who holds a master |