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General NPI Number Information
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NPI Number | 1134430705
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Entity Type | Individual
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Provider Name | MR. SPENCER LEE DEWOODY
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Gender | Male
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 2250 LATHAM ST APT 21
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-1601
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Country | US
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Telephone | 559-392-1621
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Fax |
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Provider Business Mailing Address
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Address Line | 2250 LATHAM STREET APT. 21
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040
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Country | US
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Telephone | 559-392-1621
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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 | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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