Provider Demographics
NPI:1952551699
Name:GLASSMAN, MARK F (BC-HIS,ACA)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:F
Last Name:GLASSMAN
Suffix:
Gender:M
Credentials:BC-HIS,ACA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 SHUMAN BLVD
Mailing Address - Street 2:STE 401
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60563-8458
Mailing Address - Country:US
Mailing Address - Phone:630-303-5380
Mailing Address - Fax:978-313-6824
Practice Address - Street 1:12100 W CENTER RD
Practice Address - Street 2:1203-1205
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68144-3969
Practice Address - Country:US
Practice Address - Phone:402-571-1207
Practice Address - Fax:402-573-7836
Is Sole Proprietor?:No
Enumeration Date:2008-09-30
Last Update Date:2016-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE201237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47063509001OtherTAX ID #