Provider Demographics
NPI:1679582290
Name:GLADWIN, LYDIA J (AUD)
Entity Type:Individual
Prefix:DR
First Name:LYDIA
Middle Name:J
Last Name:GLADWIN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 406153
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-1876
Mailing Address - Country:US
Mailing Address - Phone:727-849-6076
Mailing Address - Fax:727-848-2830
Practice Address - Street 1:5139 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-3966
Practice Address - Country:US
Practice Address - Phone:727-849-6076
Practice Address - Fax:727-848-2830
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY1140231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0167450OtherGHI
FL600388500Medicaid
FL600388500Medicaid