Provider Demographics
NPI:1386908937
Name:COLE, GLENDA S (MA, CCC/SLP)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:S
Last Name:COLE
Suffix:
Gender:F
Credentials:MA, CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3280 BLAZER PKWY
Mailing Address - Street 2:STE 101
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-2117
Mailing Address - Country:US
Mailing Address - Phone:859-771-1994
Mailing Address - Fax:
Practice Address - Street 1:3280 BLAZER PKWY
Practice Address - Street 2:STE 101
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-2117
Practice Address - Country:US
Practice Address - Phone:859-278-0549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1761235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist