MEDICARE: MRS. GLENDA VICTORA LOCKE M.A. C.C.C. S.L.P

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	N/A	MI

General Provider Information

NPI Number	:	1851368146
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GLENDA VICTORA LOCKE M.A. C.C.C. S.L.P

Provider Business Mailing Address
First Line	:	9070 LINDEN RD
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-9115
Country	:	US
Telephone Number	:	810-655-8296
Fax Number	:

Provider Business Practice Location Address
First Line	:	9070 LINDEN RD
Second Line	:
City	:	SWARTZ CREEK
State	:	MI
Zip	:	48473-9115
Country	:	US
Telephone Number	:	810-655-8296
Fax Number	:

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

Provider Enumeration Date	:	03/05/2006
Last Update Date	:	07/08/2007

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