Provider Demographics
NPI:1669642906
Name:PITTMAN, GLENDA E (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:GLENDA
Middle Name:E
Last Name:PITTMAN
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 HWY WW
Mailing Address - Street 2:P.O. BOX 333
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:65340
Mailing Address - Country:US
Mailing Address - Phone:660-886-2253
Mailing Address - Fax:
Practice Address - Street 1:1180 HWY WW
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340
Practice Address - Country:US
Practice Address - Phone:660-886-2253
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0053441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO493836605Medicaid