Provider Demographics
NPI:1568045672
Name:GLODOWSKI, HARLEY
Entity Type:Individual
Prefix:
First Name:HARLEY
Middle Name:
Last Name:GLODOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3352 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53402-3724
Mailing Address - Country:US
Mailing Address - Phone:262-412-1007
Mailing Address - Fax:
Practice Address - Street 1:11520 N PORT WASHINGTON RD STE 206
Practice Address - Street 2:
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-3432
Practice Address - Country:US
Practice Address - Phone:262-412-1007
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-05
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health