Individual
GLENDA K O'NEAL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CCC-SLP
Contact information
Practice address
301 LOUIS ST, SUITE 101, KINGSPORT, TN 37660-5181
(423) 246-4600
(423) 246-3311
Mailing address
301 LOUIS ST, SUITE 101, KINGSPORT, TN 37660-5181
(423) 246-4600
(423) 246-3311
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
2202002545
VA
235Z00000X
Speech-Language Pathologist
Primary
SP 1066
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004978048
—
VA
01
—
0138330
BCBS#
TN
01
—
510141536
TAX ID
—
Enumeration date
07/18/2006
Last updated
01/11/2011
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