Healthcare Provider Details

I. General information

NPI: 1598014854
Provider Name (Legal Business Name): AMANDA J GLENN CLD, CPD, CLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2012
Last Update Date: 04/02/2021
Certification Date: 03/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

855 INCA ST STE 3A
DENVER CO
80204-4342
US

IV. Provider business mailing address

2125 TABOR DR
LAKEWOOD CO
80215-1117
US

V. Phone/Fax

Practice location:
  • Phone: 720-460-0003
  • Fax:
Mailing address:
  • Phone: 720-219-8482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: