Provider Demographics
NPI:1982911202
Name:GLASSBROOK, KATHERINE NICOLE (MA, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:NICOLE
Last Name:GLASSBROOK
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:207 HEDSTROM DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14226-3434
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:167 E UTICA ST
Practice Address - Street 2:SCHOOL 81 AT SCHOOL 8
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14208-2018
Practice Address - Country:US
Practice Address - Phone:716-816-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014625-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist