Provider Demographics
NPI:1508436312
Name:GLENN, DYLAN EDWARD (MS)
Entity Type:Individual
Prefix:MR
First Name:DYLAN
Middle Name:EDWARD
Last Name:GLENN
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 S 18TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66102-5642
Mailing Address - Country:US
Mailing Address - Phone:816-550-2771
Mailing Address - Fax:
Practice Address - Street 1:155 S 18TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66102-5642
Practice Address - Country:US
Practice Address - Phone:816-550-2771
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-25
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor