Provider Demographics
NPI:1558697805
Name:GLATFELTER, MARILYNNE (PHD)
Entity Type:Individual
Prefix:
First Name:MARILYNNE
Middle Name:
Last Name:GLATFELTER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 N 1500 E
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:UT
Mailing Address - Zip Code:84321-4358
Mailing Address - Country:US
Mailing Address - Phone:435-753-3485
Mailing Address - Fax:435-753-3485
Practice Address - Street 1:786 N 1500 E
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:UT
Practice Address - Zip Code:84321-4358
Practice Address - Country:US
Practice Address - Phone:435-753-3485
Practice Address - Fax:435-753-3485
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-21
Last Update Date:2009-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT112419-2501103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist