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General NPI Number Information
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NPI Number | 1154871002
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Entity Type | Individual
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Provider Name | KAITLIN SPENCER
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Gender | Female
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 07/05/2024
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Provider Practice Location Address
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Address Line | 2721 CONNERY WAY
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City | MISSOULA
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State | MT
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Zip | 59808-1951
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Country | US
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Telephone | 406-282-4979
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3291
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City | MISSOULA
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State | MT
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Zip | 59806-3291
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Country | US
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Telephone | 406-282-4979
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Fax | 855-975-3095
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number | CB60971891
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 57510
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License Number State | MT
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