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NPI Code Detail

MEDICARE: MRS. KELLY E GLASHAUSER MA CCC/SLP

MEDICARE: MRS. KELLY E GLASHAUSER MA CCC/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
1235Z00000XSpeech-Language Pathologist012348-1NY

General Provider Information

NPI Number : 1326292608
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KELLY E GLASHAUSER MA CCC/SLP
Provider Business Mailing Address
First Line : 105 ROCKY RD
Second Line :
City : LIVERPOOL
State : NY
Zip : 13090-3730
Country : US
Telephone Number : 315-451-2099
Fax Number :
Provider Business Practice Location Address
First Line : 1 ADLER DR
Second Line :
City : EAST SYRACUSE
State : NY
Zip : 13057-1223
Country : US
Telephone Number : 315-469-1189
Fax Number : 315-492-0548
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/12/2008
Last Update Date : 11/12/2008

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