Provider Demographics
NPI:1366586471
Name:GLASSER, AMY ADAIR (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:AMY
Middle Name:ADAIR
Last Name:GLASSER
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7779 HAM RD
Mailing Address - Street 2:P.O. BOX 4
Mailing Address - City:CUSTER
Mailing Address - State:WA
Mailing Address - Zip Code:98240-9545
Mailing Address - Country:US
Mailing Address - Phone:360-392-2838
Mailing Address - Fax:360-599-8999
Practice Address - Street 1:112 OHIO ST
Practice Address - Street 2:SUITE 118
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4543
Practice Address - Country:US
Practice Address - Phone:360-392-2838
Practice Address - Fax:360-599-8999
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000072561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8802722Medicare ID - Type Unspecified