Provider Demographics
NPI:1134372691
Name:GLASS, PHELICA ANN (LMSW)
Entity type:Individual
Prefix:
First Name:PHELICA
Middle Name:ANN
Last Name:GLASS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7317 SW 33RD ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4610
Mailing Address - Country:US
Mailing Address - Phone:785-845-1213
Mailing Address - Fax:785-289-9975
Practice Address - Street 1:7317 SW 33RD ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4610
Practice Address - Country:US
Practice Address - Phone:785-845-1213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2021-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5527104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200575630AMedicaid