Provider Demographics
NPI:1114746955
Name:GLENN, MAUREEN LEE
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:LEE
Last Name:GLENN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 112TH ST SE UNIT E103
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-5089
Mailing Address - Country:US
Mailing Address - Phone:425-240-1015
Mailing Address - Fax:
Practice Address - Street 1:2133 3RD AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121-2385
Practice Address - Country:US
Practice Address - Phone:206-971-8830
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-08
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)