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General NPI Number Information
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NPI Number | 1720445976
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Entity Type | Individual
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Provider Name | ANDREA SPENCER
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Gender | Female
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Dates
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Enumeration Date | 01/19/2016
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Last Update Date | 01/19/2016
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Provider Practice Location Address
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Address Line | 201 SYCAMORE SCHOOL RD
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City | FORT WORTH
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State | TX
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Zip | 76134-5009
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Country | US
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Telephone | 817-293-7610
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Fax |
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Provider Business Mailing Address
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Address Line | 7711 PITTSFORD LN
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City | ARLINGTON
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State | TX
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Zip | 76002-4408
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Country | US
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Telephone | 214-207-1683
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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 | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 24447
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License Number State | TX
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