Provider Demographics
NPI:1962823724
Name:GLOWIAK, MATTHEW VINCENT (MS, NCC, LPC)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:VINCENT
Last Name:GLOWIAK
Suffix:
Gender:M
Credentials:MS, NCC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:616 W 5TH AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-2914
Mailing Address - Country:US
Mailing Address - Phone:630-717-7771
Mailing Address - Fax:630-206-2003
Practice Address - Street 1:616 W 5TH AVE
Practice Address - Street 2:SUITE B
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60563-2914
Practice Address - Country:US
Practice Address - Phone:630-717-7771
Practice Address - Fax:630-206-2003
Is Sole Proprietor?:No
Enumeration Date:2013-12-21
Last Update Date:2013-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.007268101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health