Provider Demographics
NPI:1699101873
Name:MCBRIDE, GLEN D JR (MA, CCCSLP)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:D
Last Name:MCBRIDE
Suffix:JR
Gender:M
Credentials:MA, CCCSLP
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 163
Mailing Address - Street 2:
Mailing Address - City:SCOTLAND
Mailing Address - State:SD
Mailing Address - Zip Code:57059-0163
Mailing Address - Country:US
Mailing Address - Phone:573-268-3711
Mailing Address - Fax:
Practice Address - Street 1:551 4TH STREET
Practice Address - Street 2:
Practice Address - City:SCOTLAND
Practice Address - State:SD
Practice Address - Zip Code:57059-0163
Practice Address - Country:US
Practice Address - Phone:573-268-3711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist