Provider Demographics
NPI:1699964197
Name:GLASGOW, CLAUDELLE RENEE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CLAUDELLE
Middle Name:RENEE
Last Name:GLASGOW
Suffix:
Gender:F
Credentials:PSYD
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 1088
Mailing Address - Street 2:
Mailing Address - City:LAKE VILLA
Mailing Address - State:IL
Mailing Address - Zip Code:60046-1088
Mailing Address - Country:US
Mailing Address - Phone:847-356-3322
Mailing Address - Fax:
Practice Address - Street 1:420 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:LAKE VILLA
Practice Address - State:IL
Practice Address - Zip Code:60046-8664
Practice Address - Country:US
Practice Address - Phone:847-356-3322
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-10-19
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical