Provider Demographics
NPI:1912150392
Name:CLIPPARD, GLENN (MA, CCC-A)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:CLIPPARD
Suffix:
Gender:M
Credentials:MA, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22151 MOROSS RD
Mailing Address - Street 2:PROF BLDG I, SUITE 223
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48236-2167
Mailing Address - Country:US
Mailing Address - Phone:313-343-3153
Mailing Address - Fax:313-343-4111
Practice Address - Street 1:22151 MOROSS RD
Practice Address - Street 2:PROF BLDG I, SUITE 223
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48236-2167
Practice Address - Country:US
Practice Address - Phone:313-343-3153
Practice Address - Fax:313-343-4111
Is Sole Proprietor?:No
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI1601000301231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist