Provider Demographics
NPI:1760199319
Name:GLASTER, JOANNA COLLEEN
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:COLLEEN
Last Name:GLASTER
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 1:310 COSMO ST
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:OR
Mailing Address - Zip Code:97127-6102
Mailing Address - Country:US
Mailing Address - Phone:775-343-2316
Mailing Address - Fax:
Practice Address - Street 1:435 NE EVANS ST
Practice Address - Street 2:
Practice Address - City:MCMINNVILLE
Practice Address - State:OR
Practice Address - Zip Code:97128-4628
Practice Address - Country:US
Practice Address - Phone:503-472-4020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-02
Last Update Date:2022-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health