Healthcare Provider Details

I. General information

NPI: 1043644081
Provider Name (Legal Business Name): DONNA JOANN SPENCER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2013
Last Update Date: 03/26/2024
Certification Date: 03/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 158 ROSE BARRACKS
VILSECK BAYERN
09112
DE

IV. Provider business mailing address

650 HUEBNER RD
FORT RILEY KS
66442-4030
US

V. Phone/Fax

Practice location:
  • Phone: 785-410-5955
  • Fax:
Mailing address:
  • Phone: 785-239-7000
  • Fax: 630-570-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW15408
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: