Healthcare Provider Details

I. General information

NPI: 1154601250
Provider Name (Legal Business Name): JENNIFER L SPENCER MS, LIMHP, LADC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/19/2011
Last Update Date: 12/15/2022
Certification Date: 12/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 N BAILEY AVE
NORTH PLATTE NE
69101-5436
US

IV. Provider business mailing address

110 N BAILEY AVE PO BOX 1209
NORTH PLATTE NE
69101-5436
US

V. Phone/Fax

Practice location:
  • Phone: 308-534-6029
  • Fax: 308-534-6961
Mailing address:
  • Phone: 308-534-6029
  • Fax: 308-534-6961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4325
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: