Provider Demographics
NPI:1457461287
Name:GLASS, GWENDOLYN B (MS CCC SLP)
Entity Type:Individual
Prefix:MS
First Name:GWENDOLYN
Middle Name:B
Last Name:GLASS
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Gender:F
Credentials:MS CCC SLP
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Mailing Address - Street 1:280 TOWERVIEW COURT
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:CARY
Mailing Address - State:NC
Mailing Address - Zip Code:27513
Mailing Address - Country:US
Mailing Address - Phone:919-380-7171
Mailing Address - Fax:919-380-9101
Practice Address - Street 1:3100 NC HIGHWAY 55
Practice Address - Street 2:SUITE 102
Practice Address - City:CARY
Practice Address - State:NC
Practice Address - Zip Code:27519-8426
Practice Address - Country:US
Practice Address - Phone:919-363-5000
Practice Address - Fax:919-363-5346
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-11-18
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1434KOtherBCBS OF NC
NC7412577Medicaid