Individual
GRACE GLIDEWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2301 W BRADLEY AVE, CHAMPAIGN, IL 61821-1849
(574) 387-4313
Mailing address
1827 E IRELAND RD, SOUTH BEND, IN 46614-2845
(574) 387-4313
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
RBT-26-546025
IL
Other
Enumeration date
06/24/2026
Last updated
06/24/2026
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