Provider Demographics
NPI:1083757900
Name:SHINNER, GLENN (AUD)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:
Last Name:SHINNER
Suffix:
Gender:M
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:241 KING ST STE 119
Mailing Address - Street 2:HAMPSHIRE HEARING SERVICES
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060-2341
Mailing Address - Country:US
Mailing Address - Phone:413-586-9572
Mailing Address - Fax:413-582-7923
Practice Address - Street 1:241 KING ST STE 119
Practice Address - Street 2:HAMPSHIRE HEARING SERVICES
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2341
Practice Address - Country:US
Practice Address - Phone:413-586-9572
Practice Address - Fax:413-582-7923
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA193231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA19923OtherHEALTH NEW ENGLAND
MA793123OtherTUFTS HEALTH PLAN
MA19918OtherHARVARD PILGRIM HEALTH PL
MA701242OtherCONNECTICARE
MAAD 0010OtherBLUE CROSS BLUE SHIELD
W67683Medicare UPIN
MAAD 0010OtherBLUE CROSS BLUE SHIELD