=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518213495
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SHIRA NAAMA GLOGOWER LCSW, LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2012
-----------------------------------------------------
Last Update Date | 09/17/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2127 UNIVERSITY PARK DR STE 300O
-----------------------------------------------------
City | OKEMOS
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48864-5928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-382-8805
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1951 GROTON WAY
-----------------------------------------------------
City | EAST LANSING
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48823-1347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-645-1884
-----------------------------------------------------
Fax | 847-568-5250
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 149017569
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number | 6801108046
-----------------------------------------------------
License Number State | MI
-----------------------------------------------------