Healthcare Provider Details

I. General information

NPI: 1508453846
Provider Name (Legal Business Name): EMILY GLODOWSKI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2020
Last Update Date: 01/04/2021
Certification Date: 01/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 WYLIE RIDGE RD
WEIRTON WV
26062-6042
US

IV. Provider business mailing address

3180 WYLIE RIDGE RD
WEIRTON WV
26062-6042
US

V. Phone/Fax

Practice location:
  • Phone: 304-374-3291
  • Fax:
Mailing address:
  • Phone: 304-374-3291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: