Individual
DAMON GLADNEY SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3510 LINWOOD AVE, SHREVEPORT, LA 71103-4512
(318) 636-4194
Mailing address
3510 LINWOOD AVE, SHREVEPORT, LA 71103-4512
(318) 636-4194
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
25100000X
—
LA
Enumeration date
01/08/2016
Last updated
05/17/2018
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