1356672828 NPI number — HEATHER L D GLESSNER M.S., C.G.C.

Table of content: HEATHER L D GLESSNER M.S., C.G.C. (NPI 1356672828)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356672828 NPI number — HEATHER L D GLESSNER M.S., C.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLESSNER
Provider First Name:
HEATHER
Provider Middle Name:
L D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., C.G.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1356672828
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 19659
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62794-9659
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-545-8000
Provider Business Mailing Address Fax Number:
217-757-6388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
415 N 9TH ST
Provider Second Line Business Practice Location Address:
SUITE 6W30
Provider Business Practice Location Address City Name:
SPRINGFIELD
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62702-5303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-545-8000
Provider Business Practice Location Address Fax Number:
217-757-6388
Provider Enumeration Date:
01/23/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 170300000X , with the licence number:  246-000086 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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