Provider Demographics
NPI:1598014854
Name:GLENN, AMANDA J (CLD, CPD, CLE)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:J
Last Name:GLENN
Suffix:
Gender:F
Credentials:CLD, CPD, CLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 TABOR DR
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80215-1117
Mailing Address - Country:US
Mailing Address - Phone:720-219-8482
Mailing Address - Fax:
Practice Address - Street 1:855 INCA ST STE 3A
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4342
Practice Address - Country:US
Practice Address - Phone:720-460-0003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator