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NPI Code Detail

MEDICARE: DR. ROBERT NEIL GLIDEWELL PSYD

MEDICARE: DR. ROBERT NEIL GLIDEWELL PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist3157CO
2103TH0004XHealth Psychologist3157CO
3103TB0200XCognitive & Behavioral Psychologist3157CO
4103TP2701XGroup Psychotherapy Psychologist3157CO

General Provider Information

NPI Number : 1871774240
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT NEIL GLIDEWELL PSYD
Provider Business Mailing Address
First Line : 1155 KELLY JOHNSON BLVD STE 111
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-3957
Country : US
Telephone Number : 719-373-0051
Fax Number : 719-373-0052
Provider Business Practice Location Address
First Line : 1155 KELLY JOHNSON BLVD STE 111
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-3957
Country : US
Telephone Number : 719-373-0051
Fax Number : 719-373-0052
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/14/2007
Last Update Date : 05/30/2024

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