Provider Demographics
NPI:1275861429
Name:GLISCZINSKI, ELIZABETH JANE (MA)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JANE
Last Name:GLISCZINSKI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14600 NW CORNELL RD
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97229-5442
Mailing Address - Country:US
Mailing Address - Phone:503-645-3581
Mailing Address - Fax:503-629-8517
Practice Address - Street 1:25435 SE MIRRORMONT DR
Practice Address - Street 2:
Practice Address - City:ISSAQUAH
Practice Address - State:WA
Practice Address - Zip Code:98027-6949
Practice Address - Country:US
Practice Address - Phone:971-322-6024
Practice Address - Fax:425-295-7668
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2021-01-21
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)