Provider Demographics
NPI:1629024567
Name:GLENZER, KYMM (AUD)
Entity Type:Individual
Prefix:
First Name:KYMM
Middle Name:
Last Name:GLENZER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18772 EVEREST PATH
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55024-7061
Mailing Address - Country:US
Mailing Address - Phone:651-460-2452
Mailing Address - Fax:
Practice Address - Street 1:6525 FRANCE AVE S
Practice Address - Street 2:SUITE 325
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-2148
Practice Address - Country:US
Practice Address - Phone:952-920-4595
Practice Address - Fax:952-920-7958
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN6431231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist