Healthcare Provider Details

I. General information

NPI: 1851886881
Provider Name (Legal Business Name): JENNIFER E SPECHT LM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2018
Last Update Date: 06/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5261 PRIVATE ROAD 5278
BAIRD TX
79504-4245
US

IV. Provider business mailing address

5261 PRIVATE ROAD 5278
BAIRD TX
79504-4245
US

V. Phone/Fax

Practice location:
  • Phone: 325-201-2945
  • Fax: 325-692-2345
Mailing address:
  • Phone: 325-201-2945
  • Fax: 325-692-2345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number99339
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: