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General NPI Number Information
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NPI Number | 1699365924
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Entity Type | Individual
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Provider Name | TERESA ANN GLENDINNING
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Gender | Female
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Dates
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Enumeration Date | 01/20/2021
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Last Update Date | 01/20/2021
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Provider Practice Location Address
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Address Line | 815 2ND AVE STE 122
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City | FAIRBANKS
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State | AK
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Zip | 99701-4469
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Country | US
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Telephone | 907-328-9664
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 81106
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City | FAIRBANKS
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State | AK
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Zip | 99708-1106
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Country | US
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Telephone | 907-328-9664
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 158639
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License Number State | AK
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