Provider Demographics
NPI:1952298598
Name:GLENN, CARLY CHRISTINE (EAMP)
Entity type:Individual
Prefix:
First Name:CARLY
Middle Name:CHRISTINE
Last Name:GLENN
Suffix:
Gender:F
Credentials:EAMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 W GOVERNMENT WAY APT 4
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98199-1335
Mailing Address - Country:US
Mailing Address - Phone:235-970-2671
Mailing Address - Fax:
Practice Address - Street 1:2946 1ST AVE S
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98134-1820
Practice Address - Country:US
Practice Address - Phone:206-307-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-18
Last Update Date:2025-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAACUP.AC.70005408171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist