Provider Demographics
NPI:1922985563
Name:GLOUDEMAN, CHANDLER
Entity type:Individual
Prefix:MS
First Name:CHANDLER
Middle Name:
Last Name:GLOUDEMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:N112W19777 GOLDENDALE RD
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53022-2994
Mailing Address - Country:US
Mailing Address - Phone:540-322-9624
Mailing Address - Fax:
Practice Address - Street 1:N112W19777 GOLDENDALE RD
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:WI
Practice Address - Zip Code:53022-2994
Practice Address - Country:US
Practice Address - Phone:540-322-9624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-18
Last Update Date:2025-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program