Provider Demographics
NPI:1679865570
Name:GLENN, CHERYL RENEE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:RENEE
Last Name:GLENN
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 1:253 HIGH RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:DINGMANS FERRY
Mailing Address - State:PA
Mailing Address - Zip Code:18328-4012
Mailing Address - Country:US
Mailing Address - Phone:570-828-8385
Mailing Address - Fax:
Practice Address - Street 1:253 HIGH RIDGE RD
Practice Address - Street 2:
Practice Address - City:DINGMANS FERRY
Practice Address - State:PA
Practice Address - Zip Code:18328-4012
Practice Address - Country:US
Practice Address - Phone:570-828-8385
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL003932L235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist