Provider Demographics
NPI:1003141458
Name:GLIDEWELL, SUZANNE JANE (MSW)
Entity Type:Individual
Prefix:
First Name:SUZANNE
Middle Name:JANE
Last Name:GLIDEWELL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:SUZANNE
Other - Middle Name:JANE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:9343 TECH CENTER DR
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95826-2563
Mailing Address - Country:US
Mailing Address - Phone:916-388-6397
Mailing Address - Fax:916-875-9970
Practice Address - Street 1:9343 TECH CENTER DR
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95826-2563
Practice Address - Country:US
Practice Address - Phone:916-388-6397
Practice Address - Fax:916-875-9970
Is Sole Proprietor?:No
Enumeration Date:2009-10-02
Last Update Date:2012-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA266871041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical