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NPI Code Detail

MEDICARE: MR. JEFFREY JAMES GLESSING M.A. CCC-SLP

MEDICARE: MR. JEFFREY JAMES GLESSING M.A. CCC-SLP
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
1235Z00000XSpeech-Language Pathologist7996MN

General Provider Information

NPI Number : 1619118346
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY JAMES GLESSING M.A. CCC-SLP
Provider Business Mailing Address
First Line : 200 6TH ST NE
Second Line :
City : BYRON
State : MN
Zip : 55920-1464
Country : US
Telephone Number : 507-272-7252
Fax Number :
Provider Business Practice Location Address
First Line : 200 6TH ST NE
Second Line :
City : BYRON
State : MN
Zip : 55920-1464
Country : US
Telephone Number : 507-272-2752
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/09/2009
Last Update Date : 03/09/2009

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