Individual
DR. GLEN C BOLTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Contact information
Practice address
310 W LOSEY ST, SCOTT AIR FORCE BASE, IL 62225-5250
(618) 256-7386
Mailing address
310 W LOSEY ST, SCOTT AIR FORCE BASE, IL 62225-5250
(618) 256-7386
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
03/21/2024
Last updated
09/09/2025
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