Provider Demographics
NPI:1275529505
Name:GLASOE, GINA M (SLP)
Entity Type:Individual
Prefix:
First Name:GINA
Middle Name:M
Last Name:GLASOE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:GINA
Other - Middle Name:M
Other - Last Name:PETERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1720 S CLIFF AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57105-2129
Mailing Address - Country:US
Mailing Address - Phone:605-334-5630
Mailing Address - Fax:605-332-5327
Practice Address - Street 1:1720 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-2129
Practice Address - Country:US
Practice Address - Phone:605-334-5630
Practice Address - Fax:605-332-5327
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA01060235Z00000X
MN5658235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD16G68GLOtherBLUE CROSS BLUE SHIELD MN
MN46-07107OtherMEDICA
SD5831620Medicaid
SD5831624Medicaid
SD5831626Medicaid
SD46-00719OtherMEDICA
SD46-00862OtherMEDICA
SD5831625Medicaid
SD46-07104OtherMEDICA
SD834472OtherARAZ
MN16G66GLOtherBLUE CROSS BLUE SHIELD MN
SD35407OtherSIOUX VALLEY HEALTH PLANS
SD46-07443OtherMEDICA