Basic Information
| Provider Information | |||||||||
| NPI: | 1275793531 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLADDEN | ||||||||
| FirstName: | JAMIE LYNNE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3120 GLENDALE AVE SUITE L | ||||||||
| Address2: | THE UNIV OF TOLEDO MEDICAL CENTER - DEPT OF PSYCHIATRY | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193835695 | ||||||||
| FaxNumber: | 4193833031 | ||||||||
| Practice Location | |||||||||
| Address1: | 3120 GLENDALE AVE SUITE L | ||||||||
| Address2: | THE UNIV OF TOLEDO MEDICAL CENTER - DEPT OF PSYCHIATRY | ||||||||
| City: | TOLEDO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4193835695 | ||||||||
| FaxNumber: | 4193833031 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2008 | ||||||||
| LastUpdateDate: | 06/11/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 35. 076076 | OH | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 2084P0800X | 35. 076076 | OH | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 2522309 | 05 | OH | MEDICAID |