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General NPI Number Information
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NPI Number | 1336189893
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Entity Type | Individual
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Provider Name | JAN S GLICK CCC-A
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Gender | Female
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 01/31/2020
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Provider Practice Location Address
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Address Line | 514 E WOOLBRIGHT RD
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City | BOYNTON BEACH
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State | FL
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Zip | 33435-6033
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Country | US
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Telephone | 561-434-9944
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Fax |
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Provider Business Mailing Address
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Address Line | 149 PLANTATION RIDGE DR STE 140
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City | MOORESVILLE
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State | NC
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Zip | 28117-9175
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Country | US
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Telephone | 704-230-0007
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Fax |
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 1601000072
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | A01525
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 231H00000X
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Taxonomy Name | Audiologist
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License Number | AY1405
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License Number State | FL
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