Provider Demographics
NPI:1851368146
Name:LOCKE, GLENDA VICTORA (MA CCC SLP)
Entity Type:Individual
Prefix:MRS
First Name:GLENDA
Middle Name:VICTORA
Last Name:LOCKE
Suffix:
Gender:F
Credentials:MA CCC SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9070 LINDEN RD
Mailing Address - Street 2:
Mailing Address - City:SWARTZ CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:48473-9115
Mailing Address - Country:US
Mailing Address - Phone:810-655-8296
Mailing Address - Fax:
Practice Address - Street 1:9070 LINDEN RD
Practice Address - Street 2:
Practice Address - City:SWARTZ CREEK
Practice Address - State:MI
Practice Address - Zip Code:48473-9115
Practice Address - Country:US
Practice Address - Phone:810-655-8296
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIN/A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist