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General NPI Number Information
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NPI Number | 1578332144
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Entity Type | Individual
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Provider Name | JOAN M. SPENCER LMT
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Gender | Female
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Dates
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Enumeration Date | 12/25/2023
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Last Update Date | 12/25/2023
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Provider Practice Location Address
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Address Line | 1520 W HARRISON ST FL 4
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City | CHICAGO
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State | IL
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Zip | 60607-3106
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Country | US
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Telephone | 312-563-2531
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Fax |
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Provider Business Mailing Address
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Address Line | 335 S TAYLOR AVE APT 2S
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City | OAK PARK
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State | IL
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Zip | 60302-3575
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Country | US
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Telephone | 630-260-2913
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 227.016023
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License Number State | IL
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