Active NPI
Jacquelyn Reed Gladden, SOCIAL WORKER
- Social Worker
- Columbia, SC
National Provider Identifier
1245307198
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Social Worker
- License
- 3032
- Practice address
- 1135 Carter St
Columbia, SC 29204-2811 - Phone
- (803) 786-1183
- NPI assigned
- Nov 29, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Social Worker | 104100000X | 3032 | SC | Primary |
Addresses
Primary practice location
1135 Carter St
Columbia, SC 29204-2811
Mailing address
402 Koon Store Rd
Columbia, SC 29203-9573
Phone (803) 754-4739
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3032 | Other | SC | SOCIAL WORKER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3032 | SC | MD | Family Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1245307198",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "402 KOON STORE RD",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292039573",
"telephone_number": "803-754-4739"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1135 CARTER ST",
"city": "COLUMBIA",
"state": "SC",
"postal_code": "292042811",
"telephone_number": "803-786-1183"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GLADDEN",
"first_name": "JACQUELYN",
"middle_name": "REED",
"name_prefix": "Mrs.",
"credential": "SOCIAL WORKER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-29",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "104100000X",
"taxonomy_group": "",
"desc": "Social Worker",
"state": "SC",
"license": "3032",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "SOCIAL WORKER",
"identifier": "3032",
"state": "SC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Columbia, SC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.