Provider Demographics
NPI:1962790527
Name:GLANTZ, MARION ANN (MS, SLP-CCC)
Entity type:Individual
Prefix:MRS
First Name:MARION
Middle Name:ANN
Last Name:GLANTZ
Suffix:
Gender:F
Credentials:MS, SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 DANBURY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-4780
Mailing Address - Country:US
Mailing Address - Phone:732-213-5577
Mailing Address - Fax:732-928-2251
Practice Address - Street 1:11 DANBURY CT
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-4780
Practice Address - Country:US
Practice Address - Phone:732-213-5577
Practice Address - Fax:732-928-2251
Is Sole Proprietor?:No
Enumeration Date:2011-07-18
Last Update Date:2011-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ41YS00178100235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist