MEDICARE: CLAUDELLE R GLASGOW, PSYD, PLLC

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	251S00000X	Community/Behavioral Health Agency	2697	OR

General Provider Information

NPI Number	:	1811479249
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLAUDELLE R GLASGOW, PSYD, PLLC

Provider Business Mailing Address
First Line	:	1105 23RD AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4859
Country	:	US
Telephone Number	:	312-804-3079
Fax Number	:

Provider Business Practice Location Address
First Line	:	1105 23RD AVE
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98122-4859
Country	:	US
Telephone Number	:	312-804-3079
Fax Number	:

Authorized Official
Title or Position	:	LICENSED PSYCHOLOGIST
Name	:	DR. CLAUDELLE R GLASGOW
Credential	:	PSYD
Telephone Number	:	312-804-3079

Provider Enumeration Date	:	09/01/2018
Last Update Date	:	07/29/2019

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