Healthcare Provider Details

I. General information

NPI: 1871900514
Provider Name (Legal Business Name): SPENCER COREY M.ED, BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 COMMERCIAL ST
KLAMATH FALLS OR
97601-5930
US

IV. Provider business mailing address

3201 CAMPUS DR
KLAMATH FALLS OR
97601-8801
US

V. Phone/Fax

Practice location:
  • Phone: 541-885-1674
  • Fax:
Mailing address:
  • Phone: 541-885-1674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberABA-B-10217265
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: