Dorian L Glaze, CCC-SLP

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

2379-154 Issued in WI

Practice address

1100 N Main St
Rice Lake, WI 54868-1238

Phone

(715) 236-6408

Fax

(715) 236-6588

NPI assigned

Apr 2, 2008

Sex

Female

Sole proprietor

No

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1207094400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1207094400000",
    "number": "1912170606",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1100 N MAIN ST",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548681238",
            "telephone_number": "715-236-6408",
            "fax_number": "715-236-6588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1100 N MAIN ST",
            "city": "RICE LAKE",
            "state": "WI",
            "postal_code": "548681238",
            "telephone_number": "715-236-6408",
            "fax_number": "715-236-6588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GLAZE",
        "first_name": "DORIAN",
        "middle_name": "L",
        "credential": "CCC-SLP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-04-02",
        "last_updated": "2008-04-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "WI",
            "license": "2379-154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "42797400",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Gemini Holdings, LLC (Dove Healthcare - Rice Lake)
• Thomas G Gerber Jr., MD
• Jonathan Ryan Gilbert, DPT
• Sharon K Gjerde, PT
• Donna L Glaser, LPC, LCPC
• Jamie Gohde, FNP
• Sarah Marie Graef, MT, BCTMB
• Lori Ann Click Gray, MD
• Roger Sloan Gray Jr., MD
• Gabrielle Griffith

• Speech-Language Pathologist in Rice Lake, WI
• Providers in Rice Lake, WI by specialty
• Speech-Language Pathologist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2008; 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.