Provider Demographics
NPI:1821102666
Name:GLAZE, NANCY PATRICIA (CCC/SLP)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:PATRICIA
Last Name:GLAZE
Suffix:
Gender:F
Credentials:CCC/SLP
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:PATRICIA
Other - Last Name:MORGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CCC/SLP
Mailing Address - Street 1:1808 STOCKTON TRL
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023-3044
Mailing Address - Country:US
Mailing Address - Phone:972-517-7670
Mailing Address - Fax:972-517-6161
Practice Address - Street 1:1201 E 15TH ST
Practice Address - Street 2:SUITE 304
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75074-6238
Practice Address - Country:US
Practice Address - Phone:972-424-0148
Practice Address - Fax:972-422-5275
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10413235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX87416TMedicare UPIN
TX7616557Medicare UPIN