Provider Demographics
NPI:1205809415
Name:GLOVER, JUSTINE C (SLP)
Entity type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:C
Last Name:GLOVER
Suffix:
Gender:F
Credentials:SLP
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Mailing Address - Street 1:6835 POLO FIELDS PKWY
Mailing Address - Street 2:
Mailing Address - City:CUMMING
Mailing Address - State:GA
Mailing Address - Zip Code:30040-5731
Mailing Address - Country:US
Mailing Address - Phone:770-889-7468
Mailing Address - Fax:770-889-5584
Practice Address - Street 1:4080 MCGINNIS FERRY RD
Practice Address - Street 2:BUILDING 300, SUITE 302
Practice Address - City:ALPHARETTA
Practice Address - State:GA
Practice Address - Zip Code:30005-3948
Practice Address - Country:US
Practice Address - Phone:678-992-1935
Practice Address - Fax:770-410-9510
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GASLP000487235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist