Provider Demographics
NPI:1154510576
Name:GLEGHORN, LONDON RACHELLE (AUD)
Entity Type:Individual
Prefix:DR
First Name:LONDON
Middle Name:RACHELLE
Last Name:GLEGHORN
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10097 MANCHESTER ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63122
Mailing Address - Country:US
Mailing Address - Phone:314-313-2289
Mailing Address - Fax:314-984-8019
Practice Address - Street 1:10097 MANCHESTER ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63122
Practice Address - Country:US
Practice Address - Phone:314-313-2289
Practice Address - Fax:314-984-8019
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2020-12-09
Deactivation Date:2018-02-13
Deactivation Code:
Reactivation Date:2020-12-02
Provider Licenses
StateLicense IDTaxonomies
MO2006011480235Z00000X
MO2013025008231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO505161109Medicaid