Provider Demographics
NPI:1265728018
Name:GLASS, AMELIA LOUISE (MS, CF-SLP)
Entity type:Individual
Prefix:MS
First Name:AMELIA
Middle Name:LOUISE
Last Name:GLASS
Suffix:
Gender:F
Credentials:MS, CF-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:2 HARBOR BEND CT
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-1478
Mailing Address - Country:US
Mailing Address - Phone:636-695-2095
Mailing Address - Fax:636-695-2080
Practice Address - Street 1:2 HARBOR BEND CT
Practice Address - Street 2:SUITE 102
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1478
Practice Address - Country:US
Practice Address - Phone:636-695-2095
Practice Address - Fax:636-695-2080
Is Sole Proprietor?:No
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010038790235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist