Healthcare Provider Details

I. General information

NPI: 1154005809
Provider Name (Legal Business Name): JONNIE R GLYNN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: RAIN GLYNN MSW

II. Dates (important events)

Enumeration Date: 06/13/2023
Last Update Date: 06/13/2023
Certification Date: 06/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1645 N DIXIE HWY STE 2
MONROE MI
48162-5231
US

IV. Provider business mailing address

5463 FERN DR
TOLEDO OH
43613-1927
US

V. Phone/Fax

Practice location:
  • Phone: 734-344-7432
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6851116550
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: