Individual provider Active NPI

Glena R Harlan, CCC-SLP

  • Speech-Language Pathologist
  • Savannah, GA
National Provider Identifier
1124122155
Registry record updated May 20, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Speech-Language PathologistTaxonomy code 235Z00000X
License
001493 Issued in GA
Practice address
10 Mall CT
Suite B
Savannah, GA 31406-3692
Phone
(912) 354-4793
Fax
(888) 429-3741
NPI assigned
Sep 11, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on May 20, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Speech-Language Pathologist 235Z00000X 001493 GA Primary

Addresses

Primary practice location

10 Mall CT
Suite B
Savannah, GA 31406-3692

Mailing address

2126 E Victory Dr
#308
Savannah, GA 31404-3918
Phone (912) 600-4206

Other identifiers 1

IdentifierTypeStateIssuer
00742167AMedicaidGA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
001493GAMDSpeech-Language Pathologist

NPI Registry JSON

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

{
    "created_epoch": "1157932800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1369008000000",
    "number": "1124122155",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2126 E VICTORY DR",
            "address_2": "#308",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314043918",
            "telephone_number": "912-600-4206",
            "fax_number": "888-429-3741"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 MALL CT",
            "address_2": "SUITE B",
            "city": "SAVANNAH",
            "state": "GA",
            "postal_code": "314063692",
            "telephone_number": "912-354-4793",
            "fax_number": "888-429-3741"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HARLAN",
        "first_name": "GLENA",
        "middle_name": "R",
        "credential": "CCC-SLP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-09-11",
        "last_updated": "2013-05-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "GA",
            "license": "001493",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00742167A",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Savannah, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 20, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.