Provider Demographics
NPI:1750546511
Name:HALE, GLENNA (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GLENNA
Middle Name:
Last Name:HALE
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 S LAFAYETTE ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH LYON
Mailing Address - State:MI
Mailing Address - Zip Code:48178-1407
Mailing Address - Country:US
Mailing Address - Phone:248-486-1110
Mailing Address - Fax:248-486-3318
Practice Address - Street 1:301 S LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-1407
Practice Address - Country:US
Practice Address - Phone:248-486-1110
Practice Address - Fax:248-486-3318
Is Sole Proprietor?:No
Enumeration Date:2008-07-22
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI00028779235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI30394OtherBCBS OF MICHIGAN