Healthcare Provider Details

I. General information

NPI: 1811261167
Provider Name (Legal Business Name): ADAM F GLUECK M.A. CCC-SLP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2012
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NE 8TH AVE
GRAND RAPIDS MN
55744-2354
US

IV. Provider business mailing address

1737 HORSESHOE LAKE RD
GRAND RAPIDS MN
55744-9773
US

V. Phone/Fax

Practice location:
  • Phone: 218-327-5800
  • Fax:
Mailing address:
  • Phone: 573-382-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number0001397
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: