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General NPI Number Information
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NPI Number | 1235819632
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Entity Type | Individual
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Provider Name | LASHONDA L SPENCE COSMETOLOGIST
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Gender | Female
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Dates
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Enumeration Date | 07/20/2023
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Last Update Date | 12/02/2023
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Provider Practice Location Address
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Address Line | 111 CEDAR RIDGE DR SUITE 101 ROOM 12
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City | DUNCANVILLE
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State | TX
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Zip | 75116
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Country | US
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Telephone | 469-835-9266
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Fax |
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Provider Business Mailing Address
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Address Line | 933 TRAILWOOD DR
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City | DESOTO
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State | TX
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Zip | 75115-5546
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Country | US
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Telephone | 469-835-9926
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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 | 335E00000X
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Taxonomy Name | Prosthetic/Orthotic Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 225000000X
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Taxonomy Name | Orthotic Fitter
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License Number | 1143976
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License Number State | TX
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