Provider Demographics
NPI:1194017483
Name:GLENN, SARAH MARIE (IBCLC, CCE, CD, RYT)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:MARIE
Last Name:GLENN
Suffix:
Gender:
Credentials:IBCLC, CCE, CD, RYT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1907 VARNER ST STE C2
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29486-8104
Mailing Address - Country:US
Mailing Address - Phone:570-350-7327
Mailing Address - Fax:
Practice Address - Street 1:1907 VARNER ST STE C2
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29486-8104
Practice Address - Country:US
Practice Address - Phone:570-350-7327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-05
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
SCL-20173174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No374J00000XNursing Service Related ProvidersDoula