Basic Information
| Provider Information | |||||||||
| NPI: | 1255472395 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GLYNN | ||||||||
| FirstName: | DENISE | ||||||||
| MiddleName: | JEAN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MA.CCC.SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 15 PEARSALL PL | ||||||||
| Address2: | |||||||||
| City: | BABYLON | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117022907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6314222010 | ||||||||
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| Practice Location | |||||||||
| Address1: | 47 HUMPHREY DR | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 117914022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5169217171 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 008878 | NY | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.