Provider Demographics
NPI:1649550732
Name:GLAD, BRUCE DWAYNE (CSW, BCBA)
Entity type:Individual
Prefix:
First Name:BRUCE
Middle Name:DWAYNE
Last Name:GLAD
Suffix:
Gender:M
Credentials:CSW, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13923 S HAYSTACK PEAK CIR
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84096-6453
Mailing Address - Country:US
Mailing Address - Phone:801-506-6695
Mailing Address - Fax:
Practice Address - Street 1:13923 S HAYSTACK PEAK CIR
Practice Address - Street 2:
Practice Address - City:RIVERTON
Practice Address - State:UT
Practice Address - Zip Code:84096-6453
Practice Address - Country:US
Practice Address - Phone:801-506-6695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2015-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program