MEDICARE: MS. AMELIA LOUISE GLASS M.S, CF-SLP

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	235Z00000X	Speech-Language Pathologist	2010038790	MO

General Provider Information

NPI Number	:	1265728018
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMELIA LOUISE GLASS M.S, CF-SLP

Provider Business Mailing Address
First Line	:	2 HARBOR BEND CT
Second Line	:	SUITE 102
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-1478
Country	:	US
Telephone Number	:	636-695-2095
Fax Number	:	636-695-2080

Provider Business Practice Location Address
First Line	:	2 HARBOR BEND CT
Second Line	:	SUITE 102
City	:	LAKE SAINT LOUIS
State	:	MO
Zip	:	63367-1478
Country	:	US
Telephone Number	:	636-695-2095
Fax Number	:	636-695-2080

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	06/21/2011

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Directions to “ MS. AMELIA LOUISE GLASS M.S, CF-SLP” Practice Location

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