Provider Demographics
NPI:1417620329
Name:ELMS, GLENN (AUD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:ELMS
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19110 MONTGOMERY VILLAGE AVE STE 120
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY VILLAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20886-3706
Mailing Address - Country:US
Mailing Address - Phone:301-977-6317
Mailing Address - Fax:301-977-8503
Practice Address - Street 1:11119 ROCKVILLE PIKE STE 210
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3200
Practice Address - Country:US
Practice Address - Phone:301-468-3977
Practice Address - Fax:301-468-3978
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT006748231H00000X
MD01618231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist