MEDICARE: ALISSA NICOLE GLOWACKI M.S., 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
1	235Z00000X	Speech-Language Pathologist	SLP011786	GA

General Provider Information

NPI Number	:	1366051518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALISSA NICOLE GLOWACKI M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	44 KROG ST NE UNIT 338
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2647
Country	:	US
Telephone Number	:	919-995-2503
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 KROG ST NE UNIT 338
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30307-2647
Country	:	US
Telephone Number	:	919-995-2503
Fax Number	:

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	07/19/2022

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Directions to “ ALISSA NICOLE GLOWACKI M.S., CCC-SLP” Practice Location

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