Provider Demographics
NPI:1619118346
Name:GLESSING, JEFFREY JAMES (MA CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:JAMES
Last Name:GLESSING
Suffix:
Gender:M
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 6TH ST NE
Mailing Address - Street 2:
Mailing Address - City:BYRON
Mailing Address - State:MN
Mailing Address - Zip Code:55920-1464
Mailing Address - Country:US
Mailing Address - Phone:507-272-7252
Mailing Address - Fax:
Practice Address - Street 1:200 6TH ST NE
Practice Address - Street 2:
Practice Address - City:BYRON
Practice Address - State:MN
Practice Address - Zip Code:55920-1464
Practice Address - Country:US
Practice Address - Phone:507-272-2752
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN7996235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist