Doctor Name: | MRS. EILEEN H GLENN |
NPI Number: | 1003823519 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | L.C.P.C. |
License Number: | |
Business Practice Address: | 708 Church St Ste 247 Evanston, IL - 602013840 |
Business Phone Number: | 8477339661 |
Business Fax Number: | 8477331571 |
Mailing Address: | 2209 Dodge Ave, EVANSTON |
State: | IL |
Postal Code: | 602013012 |
Phone Number: | 8473723736 |
Fax Number: | 8477331571 |
NPI Enumeration Date: | 08/01/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | IL |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |