Provider Demographics
NPI:1053913038
Name:SHAW, GLENDA (MAC)
Entity type:Individual
Prefix:
First Name:GLENDA
Middle Name:
Last Name:SHAW
Suffix:
Gender:F
Credentials:MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2211 ARCA DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-3462
Mailing Address - Country:US
Mailing Address - Phone:907-277-6677
Mailing Address - Fax:
Practice Address - Street 1:2211 ARCA DR
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-3462
Practice Address - Country:US
Practice Address - Phone:907-277-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health