Provider Demographics
NPI:1912450149
Name:GLENN, STEPHANIE (RD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GLENN
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14917 EL CAMINO REAL # 590881
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-2628
Mailing Address - Country:US
Mailing Address - Phone:346-202-4111
Mailing Address - Fax:
Practice Address - Street 1:14917 EL CAMINO REAL # 590881
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77062-2628
Practice Address - Country:US
Practice Address - Phone:346-202-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-23
Last Update Date:2025-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered