MEDICARE: ELLEN GLEK

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	374J00000X	Doula

General Provider Information

NPI Number	:	1730563024
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN GLEK

Provider Business Mailing Address
First Line	:	30 W SUMMIT DR
Second Line	:
City	:	EMERALD HILLS
State	:	CA
Zip	:	94062-3339
Country	:	US
Telephone Number	:	503-442-5696
Fax Number	:

Provider Business Practice Location Address
First Line	:	30 W SUMMIT DR
Second Line	:
City	:	EMERALD HILLS
State	:	CA
Zip	:	94062-3339
Country	:	US
Telephone Number	:	503-442-5696
Fax Number	:

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

Provider Enumeration Date	:	07/16/2015
Last Update Date	:	07/16/2015

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Directions to “ ELLEN GLEK ” Practice Location

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