Provider Demographics
NPI:1154005809
Name:GLYNN, JONNIE R (MSW)
Entity type:Individual
Prefix:
First Name:JONNIE
Middle Name:R
Last Name:GLYNN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:RAIN
Other - Middle Name:
Other - Last Name:GLYNN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW
Mailing Address - Street 1:5463 FERN DR
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43613-1927
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1645 N DIXIE HWY STE 2
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:MI
Practice Address - Zip Code:48162-5231
Practice Address - Country:US
Practice Address - Phone:734-344-7432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-13
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68511165501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical