Provider Demographics
NPI:1871647701
Name:GLASOW, GEORGIANA (ST)
Entity Type:Individual
Prefix:
First Name:GEORGIANA
Middle Name:
Last Name:GLASOW
Suffix:
Gender:F
Credentials:ST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HIGHLAND RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06478-1695
Mailing Address - Country:US
Mailing Address - Phone:203-615-2181
Mailing Address - Fax:
Practice Address - Street 1:636 CAMPBELL AVE
Practice Address - Street 2:
Practice Address - City:WEST HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06516-4408
Practice Address - Country:US
Practice Address - Phone:203-934-2057
Practice Address - Fax:203-934-6659
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001387235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT001387OtherSPEECH THERAPIST