Individual
JILL GLASSCO FOREMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
2510 HARTFORD RD, AUSTIN, TX 78703-2429
(512) 791-0733
Mailing address
2510 HARTFORD RD, AUSTIN, TX 78703-2429
(512) 791-0733
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
25587
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P00011BT7
—
TX
Enumeration date
09/01/2011
Last updated
07/19/2017
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