MEDICARE: GLENN JAQUESS CALLAWAY

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	171400000X	Health & Wellness Coach		CA

General Provider Information

NPI Number	:	1568301919
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN JAQUESS CALLAWAY

Provider Business Mailing Address
First Line	:	490 ANTELOPE BLVD
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-2443
Country	:	US
Telephone Number	:	530-385-0080
Fax Number	:

Provider Business Practice Location Address
First Line	:	490 ANTELOPE BLVD
Second Line	:
City	:	RED BLUFF
State	:	CA
Zip	:	96080-2443
Country	:	US
Telephone Number	:	530-385-0080
Fax Number	:

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

Provider Enumeration Date	:	03/27/2026
Last Update Date	:	03/27/2026

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Directions to “ GLENN JAQUESS CALLAWAY ” Practice Location

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