Provider Demographics
NPI:1801421532
Name:GLAUB, MICHELLE ASHLEY
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ASHLEY
Last Name:GLAUB
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 1:426 E BRISTOL ST
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3469
Mailing Address - Country:US
Mailing Address - Phone:574-266-0000
Mailing Address - Fax:574-266-0018
Practice Address - Street 1:426 E BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3469
Practice Address - Country:US
Practice Address - Phone:574-266-0000
Practice Address - Fax:574-266-0018
Is Sole Proprietor?:No
Enumeration Date:2020-03-03
Last Update Date:2020-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN17001538A237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist