Individual
DR. AUDREY A. GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
4041 RUSTON WAY, SUITE 202, TACOMA, WA 98402-5378
(253) 566-2850
(253) 761-3288
Mailing address
4041 RUSTON WAY, SUITE 202, TACOMA, WA 98402-5378
(253) 566-2850
(253) 761-3288
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY1225
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GL0001
REGENCE BLUE SHIELD ID
WA
Enumeration date
09/20/2005
Last updated
08/16/2007
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