Healthcare Provider Details

I. General information

NPI: 1487736690
Provider Name (Legal Business Name): GLENN B GELMAN PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 BRINK ST
CRYSTAL LAKE IL
60014-4302
US

IV. Provider business mailing address

14 BRINK ST
CRYSTAL LAKE IL
60014-4302
US

V. Phone/Fax

Practice location:
  • Phone: 815-455-6736
  • Fax: 815-455-9477
Mailing address:
  • Phone: 815-455-6736
  • Fax: 815-455-9477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: