Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | CA |
NPI | 1073941456 |
---|---|
Provider Name | Dr. Kari Glenn |
First Address | Sacramento, CA 95833-4435 |
Second Address | Sacramento, CA 95833-4435 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2013 |
Last Update Date | 23/10/2013 |