MEDICARE: MONICA ANN GLEN M.S., 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
1	235Z00000X	Speech-Language Pathologist	345	AK

General Provider Information

NPI Number	:	1952691149
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONICA ANN GLEN M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	13210 REEF PL
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3771
Country	:	US
Telephone Number	:	907-345-4564
Fax Number	:	907-345-4568

Provider Business Practice Location Address
First Line	:	13210 REEF PL
Second Line	:
City	:	ANCHORAGE
State	:	AK
Zip	:	99515-3771
Country	:	US
Telephone Number	:	907-345-4564
Fax Number	:	907-345-4568

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

Provider Enumeration Date	:	04/09/2011
Last Update Date	:	04/09/2011

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Directions to “ MONICA ANN GLEN M.S., CCC-SLP” Practice Location

Language	Start Address	Practice Location

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