Provider Demographics
NPI:1730563024
Name:GLEK, ELLEN
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:GLEK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:
Other - Last Name:LAVOIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:30 W SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:EMERALD HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:94062-3339
Mailing Address - Country:US
Mailing Address - Phone:503-442-5696
Mailing Address - Fax:
Practice Address - Street 1:30 W SUMMIT DR
Practice Address - Street 2:
Practice Address - City:EMERALD HILLS
Practice Address - State:CA
Practice Address - Zip Code:94062-3339
Practice Address - Country:US
Practice Address - Phone:503-442-5696
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-16
Last Update Date:2015-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula