Provider Demographics
NPI:1164676318
Name:GLASER, JENNA KAYE (MS CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:JENNA
Middle Name:KAYE
Last Name:GLASER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 W BROADWAY
Mailing Address - Street 2:1-O
Mailing Address - City:LONG BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561-3167
Mailing Address - Country:US
Mailing Address - Phone:516-241-3187
Mailing Address - Fax:
Practice Address - Street 1:421 W BROADWAY
Practice Address - Street 2:1-O
Practice Address - City:LONG BEACH
Practice Address - State:NY
Practice Address - Zip Code:11561-3167
Practice Address - Country:US
Practice Address - Phone:516-241-3187
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-13
Last Update Date:2015-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist