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General NPI Number Information
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NPI Number | 1265674824
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Entity Type | Organization
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Legal Business Name | TRESA ROEBUCK SPENCER, PHD, PLLC
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Dates
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Enumeration Date | 03/28/2009
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Last Update Date | 03/28/2009
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Provider Practice Location Address
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Address Line | 1317 BAY BRIDGE CT
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City | EDMOND
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State | OK
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Zip | 73034-7076
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Country | US
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Telephone | 405-513-5741
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Fax |
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Provider Business Mailing Address
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Address Line | 1317 BAY BRIDGE CT
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City | EDMOND
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State | OK
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Zip | 73034-7076
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Country | US
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Telephone | 405-513-5741
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | TRESA MICHELLE ROEBUCK SPENCER
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Credential | PH.D.
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Telephone | 703-863-1840
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 1078
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License Number State | OK
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