Provider Demographics
NPI:1619405479
Name:GLANVILLE, ANN MARIE MARIE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANN MARIE
Middle Name:MARIE
Last Name:GLANVILLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 SCENIC WAY
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:RI
Mailing Address - Zip Code:02822-3427
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:70 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:RI
Practice Address - Zip Code:02840-3879
Practice Address - Country:US
Practice Address - Phone:401-829-6246
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2017-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RISP01046235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RISP01046OtherRHODE ISLAND DEPT OF HEALTH
MA9936OtherCOMMONWEALTH OF MASSACHUSETTS
RI9461024OtherRHODE ISLAND DIVISIONS OF MOTOR VEHICLES
12063175OtherASHA