Individual
DR. GLEN M WURGLITZ
Active
Individual
DR. GLEN M WURGLITZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PYSD, HSPP
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
—
—
103TC0700X
Clinical Psychologist
071005590
IL
103TC0700X
Clinical Psychologist
20041231A
IN
103TC0700X
Clinical Psychologist
6301015915
MI
103TC0700X
Clinical Psychologist
Primary
PSY005163
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200918700
—
IN
Enumeration date
06/18/2006
Last updated
02/20/2020
Update your record
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