Provider Demographics
NPI:1083186944
Name:GLINIECKI, KAREN (SLP)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:GLINIECKI
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 WOODLAND TER
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURY
Mailing Address - State:NJ
Mailing Address - Zip Code:08804-3129
Mailing Address - Country:US
Mailing Address - Phone:908-581-1030
Mailing Address - Fax:
Practice Address - Street 1:7 WOODLAND TER
Practice Address - Street 2:
Practice Address - City:BLOOMSBURY
Practice Address - State:NJ
Practice Address - Zip Code:08804-3129
Practice Address - Country:US
Practice Address - Phone:908-581-1030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2018-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00110600235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ41YS00110600OtherSLP