MEDICARE: GLENN HOWARD TOBEY LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LICSW512	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013125855
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN HOWARD TOBEY LICSW

Provider Business Mailing Address
First Line	:	3815 E 3RD ST
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55804-1829
Country	:	US
Telephone Number	:	218-343-6213
Fax Number	:	218-740-4389

Provider Business Practice Location Address
First Line	:	17 1/2 N LAKE AVE RM 201
Second Line	:
City	:	DULUTH
State	:	MN
Zip	:	55802-2018
Country	:	US
Telephone Number	:	218-740-4389
Fax Number	:	218-740-4389

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	06/23/2023

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