Doctor Name: | DR. GLENNA J. HEDRICK |
NPI Number: | 1881855302 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PSY.D. |
License Number: | 408 |
Business Practice Address: | 1114 Lane 12 Lovell, WY - 824319555 |
Business Phone Number: | 3075486543 |
Business Fax Number: | |
Mailing Address: | 1114 Lane 12, LOVELL |
State: | WY |
Postal Code: | 824319555 |
Phone Number: | 3075486543 |
Fax Number: | |
NPI Enumeration Date: | 06/18/2008 |
NPI Last Update Date: | 06/18/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 408 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WY |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |