MEDICARE: LEDENIA LASHON GLENN

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1467754184
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEDENIA LASHON GLENN

Provider Business Mailing Address
First Line	:	7055 EAST LAKE MEAD APT1133
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7055 E LAKE MEAD BLVD APT 1133
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89156-1113
Country	:	US
Telephone Number	:	702-353-3246
Fax Number	:

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

Provider Enumeration Date	:	12/01/2010
Last Update Date	:	12/01/2010

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Directions to “ LEDENIA LASHON GLENN ” Practice Location

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