Provider Demographics
NPI:1619124179
Name:GLASENHARDT, DANA M (AUD)
Entity Type:Individual
Prefix:
First Name:DANA
Middle Name:M
Last Name:GLASENHARDT
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:TURPIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:5015 N PAULINA ST STE 214
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60640-2756
Mailing Address - Country:US
Mailing Address - Phone:773-805-3534
Mailing Address - Fax:773-285-6333
Practice Address - Street 1:5015 N PAULINA ST STE 214
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60640-2756
Practice Address - Country:US
Practice Address - Phone:773-805-3534
Practice Address - Fax:773-285-6333
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2021-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL147001288231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILR03029Medicare PIN