Provider Demographics
NPI:1083134456
Name:GLADNEY, LYNNETTE DENISE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LYNNETTE
Middle Name:DENISE
Last Name:GLADNEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 CONQUISTA DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80916-3923
Mailing Address - Country:US
Mailing Address - Phone:719-380-0332
Mailing Address - Fax:
Practice Address - Street 1:6540 SPECKER AVE
Practice Address - Street 2:
Practice Address - City:FORT CARSON
Practice Address - State:CO
Practice Address - Zip Code:80913-4232
Practice Address - Country:US
Practice Address - Phone:719-503-7827
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCSW.099247041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical