Provider Demographics
NPI:1760992184
Name:STENNIS, GLADYS M (PLADAC)
Entity Type:Individual
Prefix:
First Name:GLADYS
Middle Name:M
Last Name:STENNIS
Suffix:
Gender:F
Credentials:PLADAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 11275
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68111-0275
Mailing Address - Country:US
Mailing Address - Phone:402-905-6296
Mailing Address - Fax:
Practice Address - Street 1:2551 SPAULDING ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68111-2986
Practice Address - Country:US
Practice Address - Phone:402-905-6296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-11
Last Update Date:2017-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NEP-1537101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)