Provider Demographics
NPI:1821138611
Name:GLOVER, MARY SHANNON (BC-HIS)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:SHANNON
Last Name:GLOVER
Suffix:
Gender:F
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6528 RAYTOWN RD STE D
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-5023
Mailing Address - Country:US
Mailing Address - Phone:816-737-0055
Mailing Address - Fax:816-737-8834
Practice Address - Street 1:6528 RAYTOWN RD STE D
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-5023
Practice Address - Country:US
Practice Address - Phone:816-737-0055
Practice Address - Fax:816-737-8834
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOHA001222237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist