Provider Demographics
NPI:1235300229
Name:RAST, GLENDA R (AUD)
Entity Type:Individual
Prefix:
First Name:GLENDA
Middle Name:R
Last Name:RAST
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 1:948 GRUENE RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130-3919
Mailing Address - Country:US
Mailing Address - Phone:830-627-3777
Mailing Address - Fax:830-627-3778
Practice Address - Street 1:948 GRUENE RD
Practice Address - Street 2:SUITE 120
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-3919
Practice Address - Country:US
Practice Address - Phone:830-627-3777
Practice Address - Fax:830-627-3778
Is Sole Proprietor?:No
Enumeration Date:2008-03-18
Last Update Date:2015-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX51733231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist