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General NPI Number Information
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NPI Number | 1013376656
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Entity Type | Individual
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Provider Name | WAYNE SPICER JR. LCSW
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Gender | Male
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Dates
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Enumeration Date | 02/10/2016
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Last Update Date | 11/03/2016
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Provider Practice Location Address
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Address Line | 1030 W MAIN ST
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City | CARLINVILLE
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State | IL
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Zip | 62626-9200
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Country | US
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Telephone | 217-930-2106
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Fax |
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Provider Business Mailing Address
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Address Line | 9 CRESTWOOD DR
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City | CARLINVILLE
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State | IL
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Zip | 62626-1847
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Country | US
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Telephone | 217-801-1242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 149.018235
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License Number State | IL
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