Healthcare Provider Details

I. General information

NPI: 1346978079
Provider Name (Legal Business Name): AMBER GLUTH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2022
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2217 COMMERCE RD UNIT C
FOREST HILL MD
21050-2565
US

IV. Provider business mailing address

820 YVETTE DR
FOREST HILL MD
21050-2722
US

V. Phone/Fax

Practice location:
  • Phone: 443-752-0179
  • Fax:
Mailing address:
  • Phone: 443-752-0179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number0076A
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: