Provider Demographics
NPI:1801185483
Name:GLENN, JANET MARIE (L AC)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:MARIE
Last Name:GLENN
Suffix:
Gender:F
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4415 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98406-3519
Mailing Address - Country:US
Mailing Address - Phone:253-376-5101
Mailing Address - Fax:
Practice Address - Street 1:706 6TH AVE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4603
Practice Address - Country:US
Practice Address - Phone:253-376-5101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-04
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA6012562171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist