Individual
DR. KELLEY L GLASS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AU.D
Contact information
Practice address
79 HIGHLAND AVE, SUITE 304, SALEM, MA 01970-2711
(978) 741-1284
(978) 745-0203
Mailing address
15 PROSPECT AVE, SWAMPSCOTT, MA 01907-2213
(339) 440-4122
Taxonomy
Speciality
Code
Description
License number
State
237600000X
Audiologist-Hearing Aid Fitter
Primary
511
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5104050
—
MA
01
—
511
MASS STATE LICENSE
MA
01
—
AD0076
BLUE SHIELD PROVIDER NUMB
MA
Enumeration date
02/19/2007
Last updated
02/16/2010
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