Provider Demographics
NPI:1629777602
Name:NEWLEN-GLUNT, HEIDI MARIE (CDCA)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:MARIE
Last Name:NEWLEN-GLUNT
Suffix:
Gender:F
Credentials:CDCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 S HAMETOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-5013
Mailing Address - Country:US
Mailing Address - Phone:330-400-1835
Mailing Address - Fax:
Practice Address - Street 1:155 N WATER ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2418
Practice Address - Country:US
Practice Address - Phone:330-678-3006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
181619324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility