Healthcare Provider Details

I. General information

NPI: 1023948338
Provider Name (Legal Business Name): OLIVIA GLASS MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2026
Last Update Date: 05/20/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 HIGHWAY 78 W STE 200
JASPER AL
35501-3686
US

IV. Provider business mailing address

1400 HIGHWAY 78 W STE 200
JASPER AL
35501-3686
US

V. Phone/Fax

Practice location:
  • Phone: 205-512-1117
  • Fax:
Mailing address:
  • Phone: 205-512-1117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number6109
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: