Healthcare Provider Details

I. General information

NPI: 1285969444
Provider Name (Legal Business Name): SUZANNE L GLASENAPP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2009
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

525 W 5TH ST STE 219
COVINGTON KY
41011-1293
US

IV. Provider business mailing address

200 HOME RD
COVINGTON KY
41011-1942
US

V. Phone/Fax

Practice location:
  • Phone: 859-261-8768
  • Fax: 859-291-2431
Mailing address:
  • Phone: 859-261-8768
  • Fax: 859-291-2431

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLSW0000009818
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number257343
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: