Provider Demographics
NPI:1619712056
Name:GLASS, WENDY BETH
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:BETH
Last Name:GLASS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 COUNTY ROUT 51, BUILDING #1
Mailing Address - Street 2:PO BOX 608
Mailing Address - City:MALONE
Mailing Address - State:NY
Mailing Address - Zip Code:12953-4502
Mailing Address - Country:US
Mailing Address - Phone:518-483-1251
Mailing Address - Fax:518-483-2242
Practice Address - Street 1:WATERTOWN BHUC
Practice Address - Street 2:650 STATE STREET
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1251
Practice Address - Country:US
Practice Address - Phone:315-755-1251
Practice Address - Fax:315-291-6601
Is Sole Proprietor?:No
Enumeration Date:2024-06-27
Last Update Date:2024-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist