Individual
DR. PAUL KENNETH GLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
2717 N GRANDVIEW BLVD, STE. 303, WAUKESHA, WI 53188-1672
(262) 544-6486
(262) 544-6377
Mailing address
2717 N GRANDVIEW BLVD STE 303, WAUKESHA, WI 53188-1660
(262) 544-6486
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
797-057
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39018500
—
WI
Enumeration date
07/30/2006
Last updated
02/12/2009
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