Healthcare Provider Details

I. General information

NPI: 1871370957
Provider Name (Legal Business Name): JUSTIN ROSS GLADNEY LSWAIC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2023
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6505 216TH ST SW STE 100
MOUNTLAKE TERRACE WA
98043-2089
US

IV. Provider business mailing address

100 N HOWARD ST STE W
SPOKANE WA
99201-0508
US

V. Phone/Fax

Practice location:
  • Phone: 425-670-7009
  • Fax:
Mailing address:
  • Phone: 954-324-7427
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW25660
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6612C
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: