MEDICARE: JEFF GLOVER MA LADC

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	301797	MN

General Provider Information

NPI Number	:	1477788461
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFF GLOVER MA LADC

Provider Business Mailing Address
First Line	:	115 FORESTVIEW LN N
Second Line	:
City	:	PLYMOUTH
State	:	MN
Zip	:	55441-5910
Country	:	US
Telephone Number	:	763-542-9212
Fax Number	:	763-542-9248

Provider Business Practice Location Address
First Line	:	1517 HIGHWAY 13 E
Second Line	:
City	:	BURNSVILLE
State	:	MN
Zip	:	55337-2917
Country	:	US
Telephone Number	:	952-890-8879
Fax Number	:	952-890-8920

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

Provider Enumeration Date	:	05/20/2009
Last Update Date	:	09/18/2009

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Directions to “ JEFF GLOVER MA LADC” Practice Location

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