MEDICARE: MADALYNNE GLEIS

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
1	1041S0200X	School Social Worker
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	522251	OH

General Provider Information

NPI Number	:	1932790169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADALYNNE GLEIS

Provider Business Mailing Address
First Line	:	211 BURKHART AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5603
Country	:	US
Telephone Number	:	513-236-7821
Fax Number	:

Provider Business Practice Location Address
First Line	:	211 BURKHART AVE
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45215-5603
Country	:	US
Telephone Number	:	513-236-7821
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2021
Last Update Date	:	12/08/2021

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Directions to “ MADALYNNE GLEIS ” Practice Location

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