MEDICARE: MS. GWENDOLYN B GLASS MS 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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1434K	OTHER	NC	BCBS OF NC
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1457461287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GWENDOLYN B GLASS MS CCC SLP

Provider Business Mailing Address
First Line	:	280 TOWERVIEW COURT
Second Line	:	SECOND FLOOR
City	:	CARY
State	:	NC
Zip	:	27513
Country	:	US
Telephone Number	:	919-380-7171
Fax Number	:	919-380-9101

Provider Business Practice Location Address
First Line	:	3100 NC HIGHWAY 55
Second Line	:	SUITE 102
City	:	CARY
State	:	NC
Zip	:	27519-8426
Country	:	US
Telephone Number	:	919-363-5000
Fax Number	:	919-363-5346

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

Provider Enumeration Date	:	08/30/2006
Last Update Date	:	11/18/2008

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