Provider Demographics
NPI:1902297385
Name:GLADYSCHILD, KAREN J (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:J
Last Name:GLADYSCHILD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 LLOYD CTR STE 101
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-1262
Mailing Address - Country:US
Mailing Address - Phone:503-970-9131
Mailing Address - Fax:
Practice Address - Street 1:5441 SW MACADAM AVE STE 206
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3822
Practice Address - Country:US
Practice Address - Phone:503-970-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-06
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR589103TC0700X
WA966103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical