Provider Demographics
NPI:1851709729
Name:GLASER, ETHAN
Entity Type:Individual
Prefix:
First Name:ETHAN
Middle Name:
Last Name:GLASER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:975 NW SPRUCE AVE
Mailing Address - Street 2:SUITE # 101
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97330-2297
Mailing Address - Country:US
Mailing Address - Phone:541-752-2042
Mailing Address - Fax:541-752-4583
Practice Address - Street 1:975 NW SPRUCE AVE
Practice Address - Street 2:SUITE # 101
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-2297
Practice Address - Country:US
Practice Address - Phone:541-752-2042
Practice Address - Fax:541-752-4583
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-23
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORHAS-P-10140141237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist