Provider Demographics
NPI:1285969444
Name:GLASENAPP, SUZANNE L
Entity type:Individual
Prefix:
First Name:SUZANNE
Middle Name:L
Last Name:GLASENAPP
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 1:200 HOME RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-1942
Mailing Address - Country:US
Mailing Address - Phone:859-261-8768
Mailing Address - Fax:859-291-2431
Practice Address - Street 1:525 W 5TH ST STE 219
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:KY
Practice Address - Zip Code:41011-1293
Practice Address - Country:US
Practice Address - Phone:859-261-8768
Practice Address - Fax:859-291-2431
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TNLSW0000009818104100000X
KY2573431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0039794Medicaid
WI1639343320Medicaid
KY7100946460Medicaid