Provider Demographics
NPI:1912696428
Name:GLIDEWELL, ALEXIS KATHERINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:KATHERINE
Last Name:GLIDEWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ALEXIS
Other - Middle Name:KATHERINE
Other - Last Name:STONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:576 B ST STE 1A
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5269
Mailing Address - Country:US
Mailing Address - Phone:707-377-0080
Mailing Address - Fax:
Practice Address - Street 1:2418 HIDDEN VALLEY DR
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95404-2345
Practice Address - Country:US
Practice Address - Phone:707-377-0080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-02
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW665321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical