Provider Demographics
NPI:1457979098
Name:GLENN, CHANNING EDEN
Entity Type:Individual
Prefix:
First Name:CHANNING
Middle Name:EDEN
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1908 CHATEAU CIR APT 301
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:AL
Mailing Address - Zip Code:35209-5632
Mailing Address - Country:US
Mailing Address - Phone:334-430-3733
Mailing Address - Fax:
Practice Address - Street 1:2806 DR JOHN HAYNES DR
Practice Address - Street 2:
Practice Address - City:PELL CITY
Practice Address - State:AL
Practice Address - Zip Code:35125-1485
Practice Address - Country:US
Practice Address - Phone:205-884-7621
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-09
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty