Provider Demographics
NPI:1649846437
Name:GLASGOW, LAURA (MA, AT, ATC,)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:MA, AT, ATC,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 RIVERSIDE AVE STE 11
Mailing Address - Street 2:
Mailing Address - City:ADRIAN
Mailing Address - State:MI
Mailing Address - Zip Code:49221-1465
Mailing Address - Country:US
Mailing Address - Phone:517-264-2244
Mailing Address - Fax:
Practice Address - Street 1:770 RIVERSIDE AVE STE 11
Practice Address - Street 2:
Practice Address - City:ADRIAN
Practice Address - State:MI
Practice Address - Zip Code:49221-1465
Practice Address - Country:US
Practice Address - Phone:517-264-2244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI26010021952255A2300X
MIC-05156101YA0400X
MI6451022092101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101Y00000XBehavioral Health & Social Service ProvidersCounselor