Provider Demographics
NPI:1063843068
Name:GLADWELL, JESSICA (BSWLSW)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:
Last Name:GLADWELL
Suffix:
Gender:F
Credentials:BSWLSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 20580
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25362-1580
Mailing Address - Country:US
Mailing Address - Phone:304-344-9834
Mailing Address - Fax:304-344-1756
Practice Address - Street 1:510 WASHINGTON ST W
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25302-2036
Practice Address - Country:US
Practice Address - Phone:304-344-9834
Practice Address - Fax:304-344-1756
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAP00944357171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator