Healthcare Provider Details

I. General information

NPI: 1760163075
Provider Name (Legal Business Name): ABIGAIL CHRISTINE GLASTETTER PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2023
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1214 S 1ST ST APT 4
LOUISVILLE KY
40203-2883
US

IV. Provider business mailing address

1214 S 1ST ST APT 4
LOUISVILLE KY
40203-2883
US

V. Phone/Fax

Practice location:
  • Phone: 573-987-6552
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: