Healthcare Provider Details

I. General information

NPI: 1649846437
Provider Name (Legal Business Name): LAURA GLASGOW MA, AT, ATC,
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2021
Last Update Date: 08/28/2026
Certification Date: 08/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 RIVERSIDE AVE
ADRIAN MI
49221-1404
US

IV. Provider business mailing address

785 RIVERSIDE AVE STE 3
ADRIAN MI
49221-1404
US

V. Phone/Fax

Practice location:
  • Phone: 517-898-6929
  • Fax:
Mailing address:
  • Phone: 517-266-4524
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6451022092
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberC-05156
License Number StateMI
# 3
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number2601002195
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: