Provider Demographics
NPI:1902023617
Name:GLAZKO, JULIA A M (PHD)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:A M
Last Name:GLAZKO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 FAIR OAKS PKWY
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3628
Mailing Address - Country:US
Mailing Address - Phone:630-663-1214
Mailing Address - Fax:734-273-9003
Practice Address - Street 1:1945 PAULINE BLVD STE 14
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48103-5047
Practice Address - Country:US
Practice Address - Phone:734-661-2555
Practice Address - Fax:734-273-9003
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-005351103TB0200X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902023617Medicaid
13520059OtherCAQH