Provider Demographics
NPI:1699590133
Name:GLAUM, JORDAN
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GLAUM
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 1:23 MULBERRY ST
Mailing Address - Street 2:
Mailing Address - City:SICKLERVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08081-1600
Mailing Address - Country:US
Mailing Address - Phone:856-340-5367
Mailing Address - Fax:
Practice Address - Street 1:851 ROUTE 73 N STE C
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-1275
Practice Address - Country:US
Practice Address - Phone:856-983-3390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-19
Last Update Date:2024-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS01299100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist