Provider Demographics
NPI:1790452167
Name:GLADDEN, LARRY OFFIE JR
Entity Type:Individual
Prefix:MR
First Name:LARRY
Middle Name:OFFIE
Last Name:GLADDEN
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:258 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1137
Mailing Address - Country:US
Mailing Address - Phone:330-431-5673
Mailing Address - Fax:
Practice Address - Street 1:258 GRAND AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1137
Practice Address - Country:US
Practice Address - Phone:330-431-5673
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator