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General NPI Number Information
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NPI Number | 1396610259
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Entity Type | Individual
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Provider Name | AUTUMN NICOLE GLENN BCBA
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Gender | Female
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Dates
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Enumeration Date | 10/09/2025
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Last Update Date | 10/09/2025
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Provider Practice Location Address
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Address Line | 150 N MILLER RD STE 150A
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City | FAIRLAWN
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State | OH
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Zip | 44333-3713
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Country | US
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Telephone | 330-867-2240
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Fax |
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Provider Business Mailing Address
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Address Line | 150 N MILLER RD STE 150A
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City | FAIRLAWN
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State | OH
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Zip | 44333-3713
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Country | US
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Telephone | 330-867-2240
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1-25-82172
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License Number State | OH
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