Provider Demographics
NPI:1437476819
Name:GLENN, MEGAN (LMP)
Entity Type:Individual
Prefix:MRS
First Name:MEGAN
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 75
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:WA
Mailing Address - Zip Code:99352-0075
Mailing Address - Country:US
Mailing Address - Phone:509-942-4240
Mailing Address - Fax:
Practice Address - Street 1:4096 W VAN GIESEN ST
Practice Address - Street 2:
Practice Address - City:WEST RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99353-5021
Practice Address - Country:US
Practice Address - Phone:509-942-4240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-26
Last Update Date:2010-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA60144677225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist