Provider Demographics
NPI:1972083079
Name:GLADNEY, AMBER ROSE (LCSW)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:GLADNEY
Suffix:
Gender:F
Credentials:LCSW
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 865
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59806-0865
Mailing Address - Country:US
Mailing Address - Phone:406-213-5070
Mailing Address - Fax:406-204-0237
Practice Address - Street 1:526 ROLLINS ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-3721
Practice Address - Country:US
Practice Address - Phone:406-213-5070
Practice Address - Fax:406-204-0237
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2021-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT262981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical