Provider Demographics
NPI:1013125855
Name:TOBEY, GLENN HOWARD (LICSW)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:HOWARD
Last Name:TOBEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3815 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55804-1829
Mailing Address - Country:US
Mailing Address - Phone:218-343-6213
Mailing Address - Fax:218-740-4389
Practice Address - Street 1:17 1/2 N LAKE AVE RM 201
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-2018
Practice Address - Country:US
Practice Address - Phone:218-740-4389
Practice Address - Fax:218-740-4389
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLICSW5121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN706857300Medicaid