Provider Demographics
NPI:1699139758
Name:GLADER, GRETCHEN WITTE (LCSW, PHD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:WITTE
Last Name:GLADER
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:466 CENTRAL AVE
Mailing Address - Street 2:SUITE 19-21
Mailing Address - City:NORTHFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60093-3041
Mailing Address - Country:US
Mailing Address - Phone:847-345-1694
Mailing Address - Fax:
Practice Address - Street 1:466 CENTRAL AVE
Practice Address - Street 2:SUITE 19-21
Practice Address - City:NORTHFIELD
Practice Address - State:IL
Practice Address - Zip Code:60093-3041
Practice Address - Country:US
Practice Address - Phone:847-345-1694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-05
Last Update Date:2016-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149-0112701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical