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General NPI Number Information
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NPI Number | 1891459962
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Entity Type | Individual
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Provider Name | COLLIN GLAZEK
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Gender | Male
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Dates
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Enumeration Date | 10/26/2021
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Last Update Date | 10/26/2021
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Provider Practice Location Address
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Address Line | 3625 UTICA RIDGE RD STE E
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City | BETTENDORF
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State | IA
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Zip | 52722-1653
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Country | US
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Telephone | 563-526-0424
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Fax |
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Provider Business Mailing Address
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Address Line | 907 E 39TH ST APT 101
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City | DAVENPORT
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State | IA
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Zip | 52807-1713
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Country | US
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Telephone | 156-394-0679
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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 | 106E00000X
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Taxonomy Name | Assistant Behavior Analyst
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License Number | 0-21-12984
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License Number State |
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