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General NPI Number Information
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NPI Number | 1063621340
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Entity Type | Individual
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Provider Name | SELMA SELENA GLADNEY MSOM, L.AC., LMT
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 03/04/2013
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Provider Practice Location Address
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Address Line | 932 N WRIGHT ST SUITE 120
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City | NAPERVILLE
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State | IL
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Zip | 60563-3600
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Country | US
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Telephone | 630-428-9001
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Fax |
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Provider Business Mailing Address
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Address Line | 1570 AVATI LN UNIT D
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City | AURORA
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State | IL
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Zip | 60505-1647
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Country | US
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Telephone | 630-299-6754
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.005001
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 198.000930
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License Number State | IL
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