Provider Demographics
NPI:1225090012
Name:GLASSER, JEFFREY (PHD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:GLASSER
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 1:300 BOARDWALK DR
Mailing Address - Street 2:BLDG 5A
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-3070
Mailing Address - Country:US
Mailing Address - Phone:970-223-2256
Mailing Address - Fax:970-223-2324
Practice Address - Street 1:300 BOARDWALK DR
Practice Address - Street 2:BLDG 5A
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-3070
Practice Address - Country:US
Practice Address - Phone:970-223-2256
Practice Address - Fax:970-223-2324
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-05
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1917103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63216Medicare ID - Type UnspecifiedMEDICARE PART B COLORADO