Provider Demographics
NPI:1053443218
Name:CORDERO, GLENDALY (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:GLENDALY
Middle Name:
Last Name:CORDERO
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3366 EBENEZER FARM RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4452
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:888-380-2840
Practice Address - Street 1:3366 EBENEZER FARM RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4452
Practice Address - Country:US
Practice Address - Phone:888-380-2840
Practice Address - Fax:888-380-2840
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2015-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist