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General NPI Number Information
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NPI Number | 1962934588
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Entity Type | Individual
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Provider Name | DAVID GLEDITSCH MBA, CAC III
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Gender | Male
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Dates
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Enumeration Date | 04/02/2017
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Last Update Date | 04/02/2017
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Provider Practice Location Address
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Address Line | 2017 W EISENHOWER BLVD
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City | LOVELAND
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State | CO
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Zip | 80537-3139
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Country | US
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Telephone | 970-461-0978
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Fax |
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Provider Business Mailing Address
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Address Line | 4112 LAKEFRONT DR
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City | LOVELAND
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State | CO
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Zip | 80537-9610
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Country | US
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Telephone | 970-663-1132
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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 | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | ACC0006999
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License Number State | CO
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