Provider Demographics
NPI:1346485729
Name:CHANG, GLORY S (MS CCC-SLP)
Entity Type:Individual
Prefix:MISS
First Name:GLORY
Middle Name:S
Last Name:CHANG
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 NW 42ND AVE APT B410
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33066-2182
Mailing Address - Country:US
Mailing Address - Phone:917-502-5301
Mailing Address - Fax:
Practice Address - Street 1:3000 NW 42ND AVE APT B410
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33066-2182
Practice Address - Country:US
Practice Address - Phone:917-502-5301
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-12
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA19138235Z00000X
NY016941235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist