Provider Demographics
NPI:1962785121
Name:GLENN, WENDELL D (MSW)
Entity type:Individual
Prefix:MR
First Name:WENDELL
Middle Name:D
Last Name:GLENN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:346 COLEMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:SC
Mailing Address - Zip Code:29325-6936
Mailing Address - Country:US
Mailing Address - Phone:864-872-5310
Mailing Address - Fax:
Practice Address - Street 1:346 COLEMAN RD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:SC
Practice Address - Zip Code:29325-6936
Practice Address - Country:US
Practice Address - Phone:864-872-5310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-23
Last Update Date:2011-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1639470172146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic