Glaze, Dorian L
Glaze, Dorian L is an individual health care provider with primary practice located at 1100 N Main St , Rice Lake WI 54868-1238. She recently has only one registered license in Speech, Language and Hearing Service Providers / Speech-Language Pathologist, which is considered as her primary health care specialty. Glaze, Dorian L can be contacted via phone (715) 236-6408.Contact Information
Primary practice address
1100 N Main St
Rice Lake WI 54868-1238
Phone: (715) 236-6408
Fax: (715) 236-6588
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Speech, Language and Hearing Service Providers / Speech-Language Pathologist | 235Z00000X | 2379-154 | Wisconsin |
Profile Details
| NPI number | 1912170606 |
|---|---|
| LBN Legal business name | Glaze, Dorian L |
| Credentials | CCC-SLP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 2nd, 2008 |
| Last updated | Apr 2nd, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912170606 | NPPES |
| Wisconsin | MEDICAID | 42797400 |
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