Healthcare Provider Details

I. General information

NPI: 1396806915
Provider Name (Legal Business Name): RAYMOND EDGAR SPENCER M.A., CCC-A
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 WYNDHAM DR AUDIOLOGY
SACRAMENTO CA
95823-4913
US

IV. Provider business mailing address

7300 WYNDHAM DR AUDIOLOGY
SACRAMENTO CA
95823-4913
US

V. Phone/Fax

Practice location:
  • Phone: 916-525-6364
  • Fax:
Mailing address:
  • Phone: 916-525-6364
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU451
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: