Provider Demographics
NPI:1124122155
Name:HARLAN, GLENA R (CCC-SLP)
Entity type:Individual
Prefix:
First Name:GLENA
Middle Name:R
Last Name:HARLAN
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2126 E VICTORY DR
Mailing Address - Street 2:#308
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31404-3918
Mailing Address - Country:US
Mailing Address - Phone:912-600-4206
Mailing Address - Fax:888-429-3741
Practice Address - Street 1:10 MALL CT
Practice Address - Street 2:SUITE B
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3692
Practice Address - Country:US
Practice Address - Phone:912-354-4793
Practice Address - Fax:888-429-3741
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-11
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA001493235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00742167AMedicaid