Provider Demographics
NPI:1992071526
Name:SOISETH, GLENDINE (LMSW)
Entity type:Individual
Prefix:
First Name:GLENDINE
Middle Name:
Last Name:SOISETH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7047 E GREENWAY PKWY STE 250
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-8113
Mailing Address - Country:US
Mailing Address - Phone:602-420-3379
Mailing Address - Fax:
Practice Address - Street 1:7047 E GREENWAY PKWY STE 250
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-8113
Practice Address - Country:US
Practice Address - Phone:602-420-3379
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-28
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13123104100000X
MN16952104100000X
AZLCSW-157681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker