Provider Demographics
NPI:1952071169
Name:GLASGOW, ANNA MARISSA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARISSA
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17475 MOCCASIN
Mailing Address - Street 2:
Mailing Address - City:THREE RIVERS
Mailing Address - State:MI
Mailing Address - Zip Code:49093-8027
Mailing Address - Country:US
Mailing Address - Phone:517-648-8389
Mailing Address - Fax:
Practice Address - Street 1:5725 VENTURE PARK DR STE B
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49009-2816
Practice Address - Country:US
Practice Address - Phone:269-459-8889
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-18
Last Update Date:2021-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511110761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical