Healthcare Provider Details

I. General information

NPI: 1871774240
Provider Name (Legal Business Name): ROBERT NEIL GLIDEWELL PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1155 KELLY JOHNSON BLVD STE 111
COLORADO SPRINGS CO
80920-3957
US

IV. Provider business mailing address

1155 KELLY JOHNSON BLVD STE 111
COLORADO SPRINGS CO
80920-3957
US

V. Phone/Fax

Practice location:
  • Phone: 719-373-0051
  • Fax: 719-373-0052
Mailing address:
  • Phone: 719-373-0051
  • Fax: 719-373-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number3157
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number3157
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number3157
License Number StateCO
# 4
Primary TaxonomyN
Taxonomy Code103TP2701X
TaxonomyGroup Psychotherapy Psychologist
License Number3157
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: