Provider Demographics
NPI:1528216363
Name:GLENN, PATRICIA BERNICE (LMSW-CLINICAL)
Entity Type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:BERNICE
Last Name:GLENN
Suffix:
Gender:F
Credentials:LMSW-CLINICAL
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:BERNICE
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2620 TAUSEND ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-4572
Mailing Address - Country:US
Mailing Address - Phone:989-992-5836
Mailing Address - Fax:
Practice Address - Street 1:2620 TAUSEND STREET
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601
Practice Address - Country:US
Practice Address - Phone:989-992-5836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-05
Last Update Date:2008-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010861391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical