Provider Demographics
NPI:1356369110
Name:O'NEAL, GLENDA K (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:K
Last Name:O'NEAL
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 LOUIS ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-5181
Mailing Address - Country:US
Mailing Address - Phone:423-246-4600
Mailing Address - Fax:423-246-3311
Practice Address - Street 1:301 LOUIS ST
Practice Address - Street 2:SUITE 101
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-5181
Practice Address - Country:US
Practice Address - Phone:423-246-4600
Practice Address - Fax:423-246-3311
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2011-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNSP 1066235Z00000X
VA2202002545235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0138330OtherBCBS#
510141536OtherTAX ID
VA004978048Medicaid
VA004978048Medicaid