Provider Demographics
NPI:1821126368
Name:GLASS, LINDA RANEE (MA)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:RANEE
Last Name:GLASS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ESSEX LN
Mailing Address - Street 2:
Mailing Address - City:LINCOLNSHIRE
Mailing Address - State:IL
Mailing Address - Zip Code:60069-3120
Mailing Address - Country:US
Mailing Address - Phone:847-777-6830
Mailing Address - Fax:
Practice Address - Street 1:175 OLDE HALF DAY RD
Practice Address - Street 2:STE. 140-17
Practice Address - City:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3061
Practice Address - Country:US
Practice Address - Phone:847-777-6830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health