Provider Demographics
NPI:1336397140
Name:GLOVER, MICHAELA (SLP)
Entity Type:Individual
Prefix:
First Name:MICHAELA
Middle Name:
Last Name:GLOVER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:MICHAELA
Other - Middle Name:
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:35 WINDING LN
Mailing Address - Street 2:
Mailing Address - City:BASKING RIDGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07920-1558
Mailing Address - Country:US
Mailing Address - Phone:402-541-6131
Mailing Address - Fax:
Practice Address - Street 1:35 WINDING LN
Practice Address - Street 2:
Practice Address - City:BASKING RIDGE
Practice Address - State:NJ
Practice Address - Zip Code:07920-1558
Practice Address - Country:US
Practice Address - Phone:402-541-6131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00805100235Z00000X
NE1141235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist