Provider Demographics
NPI:1386776029
Name:GLASS, GAIL D (MA, SLP)
Entity type:Individual
Prefix:MS
First Name:GAIL
Middle Name:D
Last Name:GLASS
Suffix:
Gender:F
Credentials:MA, SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 395
Mailing Address - Street 2:
Mailing Address - City:ORCAS
Mailing Address - State:WA
Mailing Address - Zip Code:98280-0395
Mailing Address - Country:US
Mailing Address - Phone:360-376-3080
Mailing Address - Fax:
Practice Address - Street 1:611 SCHOOL RD
Practice Address - Street 2:
Practice Address - City:EASTSOUND
Practice Address - State:WA
Practice Address - Zip Code:98245-9456
Practice Address - Country:US
Practice Address - Phone:360-376-3080
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00001646235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7117898Medicaid
WA5623GLMedicare UPIN