Provider Demographics
NPI:1609392448
Name:FRYER, GLENN MARTIN
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:MARTIN
Last Name:FRYER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4706
Mailing Address - Country:US
Mailing Address - Phone:860-674-8558
Mailing Address - Fax:860-674-1265
Practice Address - Street 1:47 W MAIN ST
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4706
Practice Address - Country:US
Practice Address - Phone:860-674-8558
Practice Address - Fax:860-674-1265
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000367237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist