MR. GLEN OWEN SALLOWS PHD, BCBA-D
NPI 1104993153
Psychologist in Madison, WI

Active since November 28, 2006Opted out of Medicare · through Jan 13, 2028
1210 FOURIER DRIVE, SUITE #100, MADISON, WI 53717(608) 662-9327(608) 662-9041 Get Directions Write a Review

NPPES record last updated: November 17, 2015. Verified against the NPPES registry weekly; last sync: August 09, 2026.

About Mr. Glen Owen Sallows Phd, Bcba-d NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MR. GLEN OWEN SALLOWS PHD, BCBA-D (NPI 1104993153) is an individual psychologist in Madison, Wisconsin, licensed in Wisconsin (823057) and active in the NPI registry since November 2006. He has opted out of Medicare through January 13, 2028 and remains eligible to order and refer.

NPPES Registry Identity

NPI1104993153
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameMR. GLEN OWEN SALLOWSCredential: PHD, BCBA-D
Location Address1210 FOURIER DRIVE, SUITE #100Madison, WI 53717-1969
Mailing Address1210 Fourier Drive, Suite #100Madison, WI 53717-1969 · (608) 662-9327 · Fax (608) 662-9041
Fax(608) 662-9041
Sole ProprietorNo
Enumeration DateNovember 28, 2006
Last NPPES UpdateNovember 17, 2015
NPI 1104993153 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License Licensed in WI · 823057
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedBehavior AnalystTaxonomy 103K00000X · License 54-140 (WI)
1210 FOURIER DRIVE, Madison, WI 53717

Other Identifiers 2

Medicaid1104993153WI
Medicaid39020200WI

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

Opted out of Medicare

Mr. Glen Owen Sallows Phd, Bcba-d has filed a Medicare opt-out affidavit. Services are provided under private contract between the provider and the patient, and are not billed to or reimbursed by Medicare. The opt-out is on file from January 13, 2016 through January 13, 2028.

Opt-Out Effective DateJanuary 13, 2016
Opt-Out In Effect ThroughJanuary 13, 2028Opt-out affidavits renew automatically every two years unless cancelled
Eligible to Order & Refer Part B Labs & Imaging Durable Medical Equipment Home Health Agency Power Mobility DevicesAn opted-out provider can still order and refer for Medicare patients in the categories marked above, even though their own services are not covered.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Psychologist (Clinical)
1210 FOURIER DRIVE, SUITE #100
MADISON, WI 53717
Psychologist (Clinical)
1210 FOURIER DRIVE, SUITE #100
MADISON, WI 53717
Social Worker
1210 FOURIER DRIVE
MADISON, WI 53717
Behavior Analyst
1210 FOURIER DRIVE
MADISON, WI 53717
Clinical Neuropsychologist
1210 FOURIER DRIVE
MADISON, WI 53717
Psychologist
1210 FOURIER DRIVE, SUITE #100
MADISON, WI 53717

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Glen Sallows's NPI number?

The NPI number for Glen Sallows is 1104993153. It was assigned to this individual provider in the NPPES registry on November 28, 2006.

Where is Glen Sallows located?

Glen Sallows practices at 1210 Fourier Drive Suite #100, Madison, WI 53717. The listed phone number is (608) 662-9327.

What is Glen Sallows's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Glen Sallows enrolled in Medicare?

No. Glen Sallows has opted out of Medicare through January 13, 2028. Care is provided under private contracts, and Medicare does not pay for services furnished by providers who have opted out. The provider remains eligible to order and refer services for Medicare patients.

When was this NPI record last updated?

The NPPES record for Glen Sallows was last updated on November 17, 2015. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 10 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.