Provider Information for 1659588507
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GLENN PARKS MSSW
Sex: Male
NPI: 1659588507
Last Updated: 2007-07-08
Certification Date:
Certification Date:
Details
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| NPI | 1659588507 | ||||||||
| Enumeration Date | 2007-05-17 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 625 W WASHINGTON AVE MADISON, WI 53703-2637 United States Phone: | Fax: | ||||||||
| Primary Practice Address | 625 W WASHINGTON AVE MADISON, WI 53703-2637 United States Phone: 608-280-2700 | Fax: | ||||||||
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