Individual
MR. GLEN OWEN SALLOWS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD, BCBA-D
Contact information
Practice address
1210 FOURIER DRIVE, SUITE #100, MADISON, WI 53717-1969
(608) 662-9327
(608) 662-9041
Mailing address
1210 FOURIER DRIVE, SUITE #100, MADISON, WI 53717-1969
(608) 662-9327
(608) 662-9041
Taxonomy
Speciality
Code
Description
License number
State
103K00000X
Behavior Analyst
54-140
WI
103T00000X
Psychologist
Primary
823057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1104993153
—
WI
05
—
39020200
—
WI
Enumeration date
11/28/2006
Last updated
11/17/2015
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