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General NPI Number Information
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NPI Number | 1295460962
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Entity Type | Individual
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Provider Name | JENSEN CIARA SPICER
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Gender | Female
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Dates
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Enumeration Date | 07/18/2022
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Last Update Date | 12/29/2022
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Provider Practice Location Address
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Address Line | 118 E SUPERIOR ST
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City | ALMA
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State | MI
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Zip | 48801-1817
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Country | US
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Telephone | 989-285-1660
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Fax |
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Provider Business Mailing Address
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Address Line | 604 N 5TH ST
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City | COLEMAN
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State | MI
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Zip | 48618-9327
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Country | US
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Telephone | 989-513-6268
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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 | 247200000X
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Taxonomy Name | Other Technician
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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 | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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