Healthcare Provider Details

I. General information

NPI: 1952347452
Provider Name (Legal Business Name): HOWARD J GLIDDEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 E HERNDON AVE 150
FRESNO CA
93720-3359
US

IV. Provider business mailing address

1660 E HERNDON AVE 150
FRESNO CA
93720-3359
US

V. Phone/Fax

Practice location:
  • Phone: 559-431-8741
  • Fax: 559-431-8520
Mailing address:
  • Phone: 559-431-8741
  • Fax: 559-431-8520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY14145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: