Provider Demographics
NPI:1073660833
Name:SWIMMER, GLENN I (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:I
Last Name:SWIMMER
Suffix:
Gender:M
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:PO BOX 74872
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-0002
Mailing Address - Country:US
Mailing Address - Phone:419-531-3500
Mailing Address - Fax:419-531-1877
Practice Address - Street 1:3425 EXECUTIVE PKWY
Practice Address - Street 2:SUITE 230
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1326
Practice Address - Country:US
Practice Address - Phone:419-531-3500
Practice Address - Fax:419-531-1877
Is Sole Proprietor?:No
Enumeration Date:2007-01-04
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301007588103TC0700X
OH3680103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00412OtherPARAMOUNT PROV
OH000000139785OtherANTHEM PROVIDER
OH0911811Medicaid
OH000000139785OtherANTHEM PROVIDER