Provider Demographics
NPI:1902229651
Name:GLIEM, JORDON (MA)
Entity Type:Individual
Prefix:
First Name:JORDON
Middle Name:
Last Name:GLIEM
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17842 NORTHWOOD AVE
Mailing Address - Street 2:APT 17
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-2238
Mailing Address - Country:US
Mailing Address - Phone:330-347-1441
Mailing Address - Fax:
Practice Address - Street 1:2132 CASE PKWY STE A
Practice Address - Street 2:
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2383
Practice Address - Country:US
Practice Address - Phone:330-963-8600
Practice Address - Fax:330-963-8680
Is Sole Proprietor?:No
Enumeration Date:2014-01-31
Last Update Date:2016-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP.10986235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist