Provider Demographics
NPI:1366496051
Name:GLANDON, DENNIS J (CSW LPC)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:J
Last Name:GLANDON
Suffix:
Gender:M
Credentials:CSW LPC
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Mailing Address - Street 1:1200 N WEST AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49202-2179
Mailing Address - Country:US
Mailing Address - Phone:517-780-3336
Mailing Address - Fax:517-796-4561
Practice Address - Street 1:1200 N WEST AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49202-2179
Practice Address - Country:US
Practice Address - Phone:517-780-3336
Practice Address - Fax:517-796-4561
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-03-28
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI6801016082104100000X
MI6301002109104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI041285OtherVALUE OPTOINS STATE OF MI
MI8008970870OtherTRADITIONAL BLUE CROSS B