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NPI Code Detail

MEDICARE: MRS. EILEEN H GLENN L.C.P.C.

MEDICARE:  MRS. EILEEN H GLENN  L.C.P.C.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional CounselorIL

General Provider Information

NPI Number : 1003823519
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. EILEEN H GLENN L.C.P.C.
Provider Business Mailing Address
First Line : 2209 DODGE AVE
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3012
Country : US
Telephone Number : 847-372-3736
Fax Number : 847-733-1571
Provider Business Practice Location Address
First Line : 708 CHURCH ST STE 247
Second Line :
City : EVANSTON
State : IL
Zip : 60201-3840
Country : US
Telephone Number : 847-733-9661
Fax Number : 847-733-1571
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 07/08/2007

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Directions to “ MRS. EILEEN H GLENN L.C.P.C.” Practice Location

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