Provider Demographics
NPI:1013550797
Name:GLASS, KATIE PAUL
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:PAUL
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 REED ST APT 1F
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-5950
Mailing Address - Country:US
Mailing Address - Phone:267-307-4282
Mailing Address - Fax:
Practice Address - Street 1:322 REED ST APT 1F
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19147-5950
Practice Address - Country:US
Practice Address - Phone:267-307-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-24
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist