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General NPI Number Information
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NPI Number | 1285134858
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Entity Type | Organization
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Legal Business Name | SPENCER TASCH CLINIC, INC
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Dates
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Enumeration Date | 02/20/2018
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Last Update Date | 04/02/2018
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Provider Practice Location Address
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Address Line | 800 WISCONSIN ST STE 420
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City | EAU CLAIRE
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State | WI
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Zip | 54703-3588
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Country | US
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Telephone | 715-210-9284
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Fax |
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Provider Business Mailing Address
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Address Line | 800 WISCONSIN ST STE 420
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City | EAU CLAIRE
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State | WI
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Zip | 54703-3588
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Country | US
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Telephone | 715-210-9284
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | BRITA SPENCER
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Credential |
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Telephone | 715-210-9284
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 130012-121
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1231-125
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License Number State | WI
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