Provider Demographics
NPI:1952691149
Name:GLEN, MONICA ANN (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MONICA
Middle Name:ANN
Last Name:GLEN
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13210 REEF PL
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99515-3771
Mailing Address - Country:US
Mailing Address - Phone:907-345-4564
Mailing Address - Fax:907-345-4568
Practice Address - Street 1:13210 REEF PL
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99515-3771
Practice Address - Country:US
Practice Address - Phone:907-345-4564
Practice Address - Fax:907-345-4568
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-09
Last Update Date:2011-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK345235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist