Healthcare Provider Details

I. General information

NPI: 1316869993
Provider Name (Legal Business Name): OLIVIA MARIAH-RENE' GLENN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JAMES GLENN

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10842 MCGEE ST
KANSAS CITY MO
64114-5018
US

IV. Provider business mailing address

7411 E 55TH ST
KANSAS CITY MO
64129-2602
US

V. Phone/Fax

Practice location:
  • Phone: 816-708-0540
  • Fax:
Mailing address:
  • Phone: 816-708-0540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: