MEDICARE: MRS. ADRIANNA MARIE GLASGOW LLMSW

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
1	1041C0700X	Clinical Social Worker

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	S326031585547	OTHER	MI	DRIVER'S LICENSE

General Provider Information

NPI Number	:	1023734910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ADRIANNA MARIE GLASGOW LLMSW

Provider Business Mailing Address
First Line	:	1018 N VERLINDEN AVE
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48915-1458
Country	:	US
Telephone Number	:	248-933-8569
Fax Number	:

Provider Business Practice Location Address
First Line	:	15173 NORTH RD
Second Line	:
City	:	FENTON
State	:	MI
Zip	:	48430-1381
Country	:	US
Telephone Number	:	810-771-4074
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2022
Last Update Date	:	10/13/2022

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