Individual
MRS. DORETHA D. GLENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
SLP,MSP-CCC
Contact information
Practice address
501 SAINT GEORGE RD, FORT MILL, SC 29708-6973
(803) 517-1382
Mailing address
501 SAINT GEORGE RD, FORT MILL, SC 29708-6973
(803) 517-1382
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
6329
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7412292
—
NC
Enumeration date
02/07/2007
Last updated
07/09/2007
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