Provider Demographics
NPI:1578623500
Name:GLUCK, LYNDA D (MA)
Entity type:Individual
Prefix:
First Name:LYNDA
Middle Name:D
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 480184
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-1184
Mailing Address - Country:US
Mailing Address - Phone:323-851-6556
Mailing Address - Fax:323-851-6593
Practice Address - Street 1:1728 LAUREL CANYON BLVD
Practice Address - Street 2:D
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90046-2138
Practice Address - Country:US
Practice Address - Phone:323-851-6556
Practice Address - Fax:323-851-6593
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2025-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU64231H00000X
CAHA934237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
No231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHA00093400Medicaid