Provider Demographics
NPI:1063074151
Name:GLASS, RICHARD JACOB
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:JACOB
Last Name:GLASS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 GOVERNMENT CENTER LN
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:VA
Mailing Address - Zip Code:24482-2639
Mailing Address - Country:US
Mailing Address - Phone:540-245-5100
Mailing Address - Fax:
Practice Address - Street 1:18 GOVERNMENT CENTER LN
Practice Address - Street 2:
Practice Address - City:VERONA
Practice Address - State:VA
Practice Address - Zip Code:24482-2639
Practice Address - Country:US
Practice Address - Phone:540-245-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-28
Last Update Date:2019-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2204000318235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist