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Individual

MRS. GLENDA SUE STIDHAM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
IECE CERTIFIED

Contact information

Practice address
57 MILLER RD, MANCHESTER, KY 40962-5714
(606) 598-2815
(606) 598-0148
Mailing address
57 MILLER RD, MANCHESTER, KY 40962-5714
(606) 598-2815
(606) 598-0148

Taxonomy

Speciality
Code
Description
License number
State
261QP0905X
State or Local Public Health Clinic/Center
Primary
01984
KY

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01984
DEVELOPMENTAL INTERVENTIO
KY
Enumeration date
05/29/2007
Last updated
07/08/2007
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