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General NPI Number Information
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NPI Number | 1013125855
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Entity Type | Individual
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Provider Name | GLENN HOWARD TOBEY LICSW
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Gender | Male
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Dates
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Enumeration Date | 05/17/2007
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Last Update Date | 06/23/2023
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Provider Practice Location Address
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Address Line | 17 1/2 N LAKE AVE RM 201
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City | DULUTH
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State | MN
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Zip | 55802-2018
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Country | US
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Telephone | 218-740-4389
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Fax | 218-740-4389
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Provider Business Mailing Address
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Address Line | 3815 E 3RD ST
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City | DULUTH
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State | MN
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Zip | 55804-1829
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Country | US
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Telephone | 218-343-6213
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Fax | 218-740-4389
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LICSW512
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License Number State | MN
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