Provider Demographics
NPI:1255730867
Name:GLAZER, ELLEN (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:ELLEN
Middle Name:
Last Name:GLAZER
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:952 SPINNAKER RD
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-4762
Mailing Address - Country:US
Mailing Address - Phone:423-381-0979
Mailing Address - Fax:423-252-0473
Practice Address - Street 1:915 CONGRESS PKWY N
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TN
Practice Address - Zip Code:37303-1740
Practice Address - Country:US
Practice Address - Phone:423-381-0979
Practice Address - Fax:423-252-0473
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4577235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist