Individual
GLEN ROBERT TAYLOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
275 W 12TH ST, PERU, IN 46970-1638
(765) 472-8000
Mailing address
508 APACHE DR, PERU, IN 46970-2929
(248) 807-7411
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Enumeration date
07/02/2018
Last updated
07/02/2018
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