Provider Demographics
NPI:1891065629
Name:GLANT, KECHYAN SWUN (MA CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:KECHYAN
Middle Name:SWUN
Last Name:GLANT
Suffix:
Gender:F
Credentials:MA CCC/SLP
Other - Prefix:MRS
Other - First Name:CASEY
Other - Middle Name:SWUN
Other - Last Name:GLANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA CCC/SLP
Mailing Address - Street 1:525 NW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:HIGH SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32643-0110
Mailing Address - Country:US
Mailing Address - Phone:386-454-2983
Mailing Address - Fax:
Practice Address - Street 1:6700 NW 10TH PL
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4213
Practice Address - Country:US
Practice Address - Phone:352-331-6280
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-10
Last Update Date:2012-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA2454235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist