MEDICARE: JOHN GLOVER LCSW

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	1041C0700X	Clinical Social Worker	872122	WI

General Provider Information

NPI Number	:	1740256999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN GLOVER LCSW

Provider Business Mailing Address
First Line	:	5708 CURTIS ST
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-9605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5708 CURTIS ST
Second Line	:
City	:	MC FARLAND
State	:	WI
Zip	:	53558-9605
Country	:	US
Telephone Number	:	608-509-3553
Fax Number	:

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

Provider Enumeration Date	:	02/27/2006
Last Update Date	:	10/28/2016

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