Audrey A. Glenn, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

PSY1225 Issued in WA

Practice address

4041 Ruston Way
Suite 202
Tacoma, WA 98402-5378

Phone

(253) 566-2850

Fax

(253) 761-3288

NPI assigned

Sep 20, 2005

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

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 1, 2016 through Jan 1, 2028

Medicare enrollment (NPD)

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.

• Mary K. Simonson, MD PLLC

  • Medical Specialty Clinic/Center
  • Tacoma, WA
  • NPI 1295334555
  NPD (past)

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

{
    "created_epoch": "1127174400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1187222400000",
    "number": "1184610735",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4041 RUSTON WAY",
            "address_2": "SUITE 202",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025378",
            "telephone_number": "253-566-2850",
            "fax_number": "253-761-3288"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4041 RUSTON WAY",
            "address_2": "SUITE 202",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "984025378",
            "telephone_number": "253-566-2850",
            "fax_number": "253-761-3288"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLENN",
        "first_name": "AUDREY",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-09-20",
        "last_updated": "2007-08-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WA",
            "license": "PSY1225",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD ID",
            "identifier": "GL0001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Marshall Aaron Glass, LMHCA, SUDP
• Sandy Paul Glassberg, M.D.
• Brittany Glassett, PA-C
• Mark Richard Gleisner, DDS
• Amy M Glenn, ARNP
• Barbie Andria Glenn
• Janet Marie Glenn, L. AC
• Jospeh W Glenn, NP-C
• Thomas William Glenn, RN
• Jenna Glenzel

• Psychologist in Tacoma, WA
• Providers in Tacoma, WA by specialty
• Psychologist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 16, 2007; 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.