Provider Demographics
NPI:1821524166
Name:GLAB, JESSICA (APSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:GLAB
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1519 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:GRAFTON
Mailing Address - State:WI
Mailing Address - Zip Code:53024-2360
Mailing Address - Country:US
Mailing Address - Phone:414-254-8403
Mailing Address - Fax:
Practice Address - Street 1:101 FALLS RD STE 600
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:WI
Practice Address - Zip Code:53024-2612
Practice Address - Country:US
Practice Address - Phone:414-254-8403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI130532121104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker