Provider Demographics
NPI:1710603204
Name:GLASSFORD, AMBER M
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:M
Last Name:GLASSFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 KENNET CT NW
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44708-4957
Mailing Address - Country:US
Mailing Address - Phone:330-413-0805
Mailing Address - Fax:
Practice Address - Street 1:515 KENNET CT NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44708-4957
Practice Address - Country:US
Practice Address - Phone:330-413-0805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-17
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251J00000X, 3747A0650X, 374U00000X, 385H00000X, 103K00000X, 251C00000X, 172V00000X, 174200000X
OH400712260108376K00000X
OH106E00000X
OHSJ633064172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No3747A0650XNursing Service Related ProvidersTechnicianAttendant Care ProviderGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's Aide
No385H00000XRespite Care FacilityRespite CareGroup - Multi-Specialty
No106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No251C00000XAgenciesDay Training, Developmentally Disabled ServicesGroup - Multi-Specialty
No172A00000XOther Service ProvidersDriverGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health Worker
No174200000XOther Service ProvidersMeals