Provider Demographics
NPI:1619799434
Name:NELSON-GLENN, YEJIDE ANN (TEACHING CREDENTIAL)
Entity type:Individual
Prefix:
First Name:YEJIDE
Middle Name:ANN
Last Name:NELSON-GLENN
Suffix:
Gender:F
Credentials:TEACHING CREDENTIAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1207 DELAWARE AVE # 3776
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-4743
Mailing Address - Country:US
Mailing Address - Phone:707-486-9368
Mailing Address - Fax:
Practice Address - Street 1:2659 HEATHER ST
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95242-9777
Practice Address - Country:US
Practice Address - Phone:707-486-9368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2025-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty