| Glenn Sherwood | |
|
425 N Baltimore Ave Ste 1 Derby KS 67037-1625 | |
| (316) 866-2882 | |
| (316) 866-2811 |
| Full Name | Glenn Sherwood |
|---|---|
| Speciality | Social Worker |
| Location | 425 N Baltimore Ave Ste 1, Derby, Kansas |
| Authorized Official Name and Position | Glenn Keith Sherwood (OWNER) |
| Authorized Official Contact | 3168662882 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glenn Sherwood 425 N Baltimore Ave Ste 1 Derby KS 67037-1625 Ph: (316) 866-2882 | Glenn Sherwood 425 N Baltimore Ave Ste 1 Derby KS 67037-1625 Ph: (316) 866-2882 |
| NPI Number | 1376906487 |
|---|---|
| Provider Enumeration Date | 04/05/2016 |
| Last Update Date | 04/18/2016 |
| Medicare PECOS PAC ID | 6305136151 |
|---|---|
| Medicare Enrollment ID | O20160607000639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1376906487 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YA0400X | Counselor - Addiction (substance Use Disorder) | 003 (Kansas) | Secondary |
| 1041C0700X | Social Worker - Clinical | 4118 (Kansas) | Primary |
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