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General NPI Number Information
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NPI Number | 1477126159
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Entity Type | Individual
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Provider Name | SPENCER M GILLIAM
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Gender | Male
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Dates
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Enumeration Date | 07/21/2021
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 96 GRASSO PLZ
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City | SAINT LOUIS
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State | MO
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Zip | 63123-3108
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Country | US
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Telephone | 636-398-2515
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Fax |
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Provider Business Mailing Address
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Address Line | 9841 HUNTINGDON LN
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City | SAINT LOUIS
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State | MO
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Zip | 63123-6415
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Country | US
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Telephone | 614-323-3109
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 2025050192
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License Number State | MO
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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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