Provider Demographics
NPI:1922728948
Name:GLASS, BRITTNEY (MA CF-SLP)
Entity Type:Individual
Prefix:
First Name:BRITTNEY
Middle Name:
Last Name:GLASS
Suffix:
Gender:F
Credentials:MA CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 PINE CONE LN
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:MO
Mailing Address - Zip Code:63957-5634
Mailing Address - Country:US
Mailing Address - Phone:314-225-9014
Mailing Address - Fax:
Practice Address - Street 1:825 N MAIN ST
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:MO
Practice Address - Zip Code:63957-1222
Practice Address - Country:US
Practice Address - Phone:573-223-4812
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-30
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2022029620235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2022029620OtherMISSOURI STATE BOARD LICENSE