Provider Demographics
NPI:1053152090
Name:GLENN, LINDSEY MARIE
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:GLENN
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 1:808 W MAIN ST APT F
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:45140-2517
Mailing Address - Country:US
Mailing Address - Phone:513-663-2133
Mailing Address - Fax:
Practice Address - Street 1:808 W MAIN ST APT F
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:OH
Practice Address - Zip Code:45140-2517
Practice Address - Country:US
Practice Address - Phone:513-663-2133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-04
Last Update Date:2024-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS005232175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist