Provider Demographics
NPI:1437478377
Name:GLAZER, SHIRLEY LYDIA
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:LYDIA
Last Name:GLAZER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11420 STRAND DR APT 11
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2949
Mailing Address - Country:US
Mailing Address - Phone:206-979-4809
Mailing Address - Fax:
Practice Address - Street 1:8901 WISCONSIN AVE AMERICA BUILDING 19; FLOOR 5
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20889-7529
Practice Address - Country:US
Practice Address - Phone:206-979-4809
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-18
Last Update Date:2024-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001450235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist