Provider Demographics
NPI:1215254438
Name:HAYDEN, GLENDA BAILEY (LMSW, LLP)
Entity type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:BAILEY
Last Name:HAYDEN
Suffix:
Gender:F
Credentials:LMSW, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3135 ENGLEHURST AVE SW
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49548-1032
Mailing Address - Country:US
Mailing Address - Phone:616-248-3794
Mailing Address - Fax:
Practice Address - Street 1:3135 ENGLEHURST AVE SW
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49548-1032
Practice Address - Country:US
Practice Address - Phone:616-248-3794
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI630-101-0081103TC2200X
MI680-108-23181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent