Healthcare Provider Details

I. General information

NPI: 1013125855
Provider Name (Legal Business Name): GLENN HOWARD TOBEY LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2007
Last Update Date: 06/23/2023
Certification Date: 06/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 1/2 N LAKE AVE RM 201
DULUTH MN
55802-2018
US

IV. Provider business mailing address

3815 E 3RD ST
DULUTH MN
55804-1829
US

V. Phone/Fax

Practice location:
  • Phone: 218-740-4389
  • Fax: 218-740-4389
Mailing address:
  • Phone: 218-343-6213
  • Fax: 218-740-4389

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW512
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: