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NPI Code Detail

MEDICARE: KATHLEEN D GLAUS PHD, PSYD

MEDICARE:   KATHLEEN D GLAUS  PHD, PSYD
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
1103TC0700XClinical Psychologist2543OH

General Provider Information

NPI Number : 1477797298
Entity Type Code : Individual
Provider Name (Legal Business Name) : KATHLEEN D GLAUS PHD, PSYD
Provider Business Mailing Address
First Line : 1105 WATERVLIET AVE
Second Line :
City : DAYTON
State : OH
Zip : 45420-2719
Country : US
Telephone Number : 937-256-0500
Fax Number : 937-256-2136
Provider Business Practice Location Address
First Line : 1105 WATERVLIET AVE
Second Line :
City : DAYTON
State : OH
Zip : 45420-2719
Country : US
Telephone Number : 937-256-0500
Fax Number : 937-256-2136
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2009
Last Update Date : 04/23/2009

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