Provider Demographics
NPI:1538994447
Name:GLENNON, MAURA E (MS CCC-SLP)
Entity type:Individual
Prefix:
First Name:MAURA
Middle Name:E
Last Name:GLENNON
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 SEBASTIAN DR
Mailing Address - Street 2:
Mailing Address - City:ALIQUIPPA
Mailing Address - State:PA
Mailing Address - Zip Code:15001-1193
Mailing Address - Country:US
Mailing Address - Phone:814-691-8405
Mailing Address - Fax:
Practice Address - Street 1:112 SEBASTIAN DR
Practice Address - Street 2:
Practice Address - City:ALIQUIPPA
Practice Address - State:PA
Practice Address - Zip Code:15001-1193
Practice Address - Country:US
Practice Address - Phone:814-691-8405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASL016756251300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)