Shade, Gladys
Shade, Gladys is an individual health care provider with primary practice located at 1890 Waite St Suite 1, North Bend OR 97459-1229. She recently has only one registered license in Behavioral Health & Social Service Providers / Clinical, which is considered as her primary health care specialty. Shade, Gladys can be contacted via phone (541) 756-6232.Contact Information
Primary practice address
1890 Waite St Suite 1
North Bend OR 97459-1229
Phone: (541) 756-6232
Fax: (541) 756-6234
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 1041C0700X | 3124 | Oregon |
Profile Details
| NPI number | 1114137494 |
|---|---|
| LBN Legal business name | Shade, Gladys |
| Credentials | QMHP, LCSW |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 23rd, 2007 |
| Last updated | Dec 2nd, 2008 - about 16 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1114137494 | NPPES |
| Oregon | Other | R142063 | MEDICARE PTAN |
| Oregon | Other | 1619915113 | MEDICARE PTAN |
| Oregon | Other | R120353 | MEDICARE PTAN |
| Oregon | MEDICAID | 213342 | MEDICARE PTAN |
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