Provider Demographics
NPI:1598035271
Name:GLAZE, SARAH A (MS)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:A
Last Name:GLAZE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MISS
Other - First Name:SARAH
Other - Middle Name:A
Other - Last Name:KING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15655 COUNTY ROAD B
Mailing Address - Street 2:P.O, BOX 13251
Mailing Address - City:HAYWARD
Mailing Address - State:WI
Mailing Address - Zip Code:54843-3251
Mailing Address - Country:US
Mailing Address - Phone:715-634-0607
Mailing Address - Fax:717-634-0617
Practice Address - Street 1:15655 COUNTY ROAD B
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:WI
Practice Address - Zip Code:54843-3251
Practice Address - Country:US
Practice Address - Phone:715-634-0607
Practice Address - Fax:715-634-0617
Is Sole Proprietor?:No
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional