Healthcare Provider Details

I. General information

NPI: 1871587741
Provider Name (Legal Business Name): GLENN HLADEK MS, CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W KENT AVE
MISSOULA MT
59801-6772
US

IV. Provider business mailing address

700 W KENT AVE PO BOX 4907
MISSOULA MT
59801-6772
US

V. Phone/Fax

Practice location:
  • Phone: 406-541-3277
  • Fax: 406-541-3950
Mailing address:
  • Phone: 406-541-3277
  • Fax: 406-541-3950

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number335
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: