Provider Demographics
NPI:1871774240
Name:GLIDEWELL, ROBERT NEIL (PSYD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:NEIL
Last Name:GLIDEWELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 KELLY JOHNSON BLVD STE 111
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80920-3957
Mailing Address - Country:US
Mailing Address - Phone:719-373-0051
Mailing Address - Fax:719-373-0052
Practice Address - Street 1:1155 KELLY JOHNSON BLVD STE 111
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920-3957
Practice Address - Country:US
Practice Address - Phone:719-373-0051
Practice Address - Fax:719-373-0052
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-14
Last Update Date:2024-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3157103TC0700X, 103TH0004X, 103TB0200X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy