Provider Demographics
NPI:1619156072
Name:GLOSSO SPEECH, LANGUAGE AND EDUCATIONAL SVCS, INC.
Entity Type:Organization
Organization Name:GLOSSO SPEECH, LANGUAGE AND EDUCATIONAL SVCS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VERLYN
Authorized Official - Middle Name:MOORE
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:EDD
Authorized Official - Phone:336-889-0077
Mailing Address - Street 1:PO BOX 31
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:NC
Mailing Address - Zip Code:27282-0031
Mailing Address - Country:US
Mailing Address - Phone:336-889-0077
Mailing Address - Fax:
Practice Address - Street 1:1700 DEEP RIVER RD
Practice Address - Street 2:
Practice Address - City:HIGH POINT
Practice Address - State:NC
Practice Address - Zip Code:27265-2568
Practice Address - Country:US
Practice Address - Phone:336-889-0077
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC251C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8300018Medicaid
NC8300018KMedicaid