Provider Demographics
NPI:1508189630
Name:GLADUE, CHELSEA ADRIANNA (SLP)
Entity Type:Individual
Prefix:
First Name:CHELSEA
Middle Name:ADRIANNA
Last Name:GLADUE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 N COLLEGE PARK DR
Mailing Address - Street 2:APT. R11
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-8883
Mailing Address - Country:US
Mailing Address - Phone:909-623-2020
Mailing Address - Fax:909-992-3173
Practice Address - Street 1:1902 ROYALTY DR
Practice Address - Street 2:SUITE 270
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-3030
Practice Address - Country:US
Practice Address - Phone:909-623-2020
Practice Address - Fax:909-992-3173
Is Sole Proprietor?:No
Enumeration Date:2010-03-03
Last Update Date:2010-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17196235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist