MEDICARE: MS. SANDRA G GLENN LCSW

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	23241	TX

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558386755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SANDRA G GLENN LCSW

Provider Business Mailing Address
First Line	:	11631 CHESSWOOD DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77072-1330
Country	:	US
Telephone Number	:	713-480-1122
Fax Number	:

Provider Business Practice Location Address
First Line	:	13426 INDIANAPOLIS ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77015-3827
Country	:	US
Telephone Number	:	713-480-1122
Fax Number	:

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

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	07/09/2007

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