Provider Demographics
NPI:1174254551
Name:GLASER, KATHERINE ELIZABETH
Entity Type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ELIZABETH
Last Name:GLASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2510 S BRYAN ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-3612
Mailing Address - Country:US
Mailing Address - Phone:812-319-7376
Mailing Address - Fax:
Practice Address - Street 1:315 W DODDS ST
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-2510
Practice Address - Country:US
Practice Address - Phone:812-319-7376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99112192A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker