Provider Demographics
NPI:1801850458
Name:KLECKNER, GLEN THOMAS (MED)
Entity type:Individual
Prefix:MR
First Name:GLEN
Middle Name:THOMAS
Last Name:KLECKNER
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1259 S CEDAR CREST BOULEVARD
Mailing Address - Street 2:SUITE 322
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18103-6206
Mailing Address - Country:US
Mailing Address - Phone:610-435-8299
Mailing Address - Fax:610-435-1940
Practice Address - Street 1:1259 S CEDAR CREST BOULEVARD
Practice Address - Street 2:SUITE 322
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18103-6206
Practice Address - Country:US
Practice Address - Phone:610-435-8299
Practice Address - Fax:610-435-1940
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAAT000175L237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013248OtherAETNA
PA02653200OtherCAPITAL BLUECROSS
PA0013248OtherAETNA