Healthcare Provider Details

I. General information

NPI: 1023092798
Provider Name (Legal Business Name): LOUISE M GLOTZBACH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 E RED BRIDGE RD SUITE 304
KANSAS CITY MO
64131-4035
US

IV. Provider business mailing address

12842 SAGAMORE RD
LEAWOOD KS
66209-1601
US

V. Phone/Fax

Practice location:
  • Phone: 816-942-1811
  • Fax: 816-942-0419
Mailing address:
  • Phone: 913-338-5034
  • Fax: 913-338-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPY 01212
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: