Individual
GEORGIA P GLAZE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LSW
Contact information
Practice address
1400 HUDSON ST, ELKHART, IN 46516-2023
(574) 522-0104
(574) 522-1902
Mailing address
1400 HUDSON ST, ELKHART, IN 46516-2023
(574) 522-0104
(574) 522-1902
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
33002586A
IN
Other
Enumeration date
11/25/2009
Last updated
11/25/2009
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