=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902023617
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JULIA A. M. GLAZKO PH.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/20/2007
-----------------------------------------------------
Last Update Date | 01/27/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1945 PAULINE BLVD STE 14
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48103-5047
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 734-661-2555
-----------------------------------------------------
Fax | 734-273-9003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1245 FAIR OAKS PKWY
-----------------------------------------------------
City | ANN ARBOR
-----------------------------------------------------
State | MI
-----------------------------------------------------
Zip | 48104-3628
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 630-663-1214
-----------------------------------------------------
Fax | 734-273-9003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TB0200X
-----------------------------------------------------
Taxonomy Name | Cognitive & Behavioral Psychologist
-----------------------------------------------------
License Number | 071-005351
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 071-005351
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------