Glen Owen Sallows, PHD, BCBA-D

Primary specialty

PsychologistTaxonomy code 103T00000X

License

823057 Issued in WI

Practice address

1210 Fourier Drive
Suite #100
Madison, WI 53717-1969

Phone

(608) 662-9327

Fax

(608) 662-9041

NPI assigned

Nov 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jan 13, 2016 through Jan 13, 2028

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Autism Spectrum Therapies of Delaware, LLC

  • Clinical Psychologist
  • Madison, WI
  • NPI 1043406978

  Behavior Analyst

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1447718400000",
    "number": "1104993153",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1210 FOURIER DRIVE",
            "address_2": "SUITE #100",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171969",
            "telephone_number": "608-662-9327",
            "fax_number": "608-662-9041"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1210 FOURIER DRIVE",
            "address_2": "SUITE #100",
            "city": "MADISON",
            "state": "WI",
            "postal_code": "537171969",
            "telephone_number": "608-662-9327",
            "fax_number": "608-662-9041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SALLOWS",
        "first_name": "GLEN",
        "middle_name": "OWEN",
        "name_prefix": "Mr.",
        "credential": "PHD, BCBA-D",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-11-28",
        "last_updated": "2015-11-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "823057",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "WI",
            "license": "54-140",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1104993153",
            "state": "WI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "39020200",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Muqaddam Salim, MD
• Robert J Salinger, MD
• Elizabeth Marie Salisbury Afshar, M.D., MPH
• Lonie R Salkowski, MD
• Qiana Sallah, RN
• Gail Salm, LPN
• Kristin Marie Salm, RN
• Farhan Salman, MD
• Kimberly M Saltow, NP
• Francis A. Salud

• Psychologist in Madison, WI
• Providers in Madison, WI by specialty
• Psychologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.