Provider Demographics
NPI:1952347452
Name:GLIDDEN, HOWARD J (PHD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:J
Last Name:GLIDDEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 E HERNDON AVE
Mailing Address - Street 2:150
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-3359
Mailing Address - Country:US
Mailing Address - Phone:559-431-8741
Mailing Address - Fax:559-431-8520
Practice Address - Street 1:1660 E HERNDON AVE
Practice Address - Street 2:150
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-3359
Practice Address - Country:US
Practice Address - Phone:559-431-8741
Practice Address - Fax:559-431-8520
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14145103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL141450Medicare ID - Type Unspecified