| Doctor Name: | MR. GLENN WOHL |
| NPI Number: | 1578578019 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LISW |
| License Number: | I-1306 |
| Business Practice Address: | Hc 69 Box 47 Sapello, NM - 877459604 |
| Business Phone Number: | 5054548381 |
| Business Fax Number: | |
| Mailing Address: | Hc 69 Box 47, SAPELLO |
| State: | NM |
| Postal Code: | 877459604 |
| Phone Number: | 5054548381 |
| Fax Number: | |
| NPI Enumeration Date: | 07/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | I-1306 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |