Provider Demographics
NPI:1962934588
Name:GLEDITSCH, DAVID (MBA, CAC III)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GLEDITSCH
Suffix:
Gender:M
Credentials:MBA, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4112 LAKEFRONT DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80537-9610
Mailing Address - Country:US
Mailing Address - Phone:970-663-1132
Mailing Address - Fax:
Practice Address - Street 1:2017 W EISENHOWER BLVD
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80537-3139
Practice Address - Country:US
Practice Address - Phone:970-461-0978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-02
Last Update Date:2017-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COACC0006999101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)