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General NPI Number Information
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NPI Number | 1932331345
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Entity Type | Organization
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Legal Business Name | JENNIFER SPENCER PHD HSPP PC
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Dates
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Enumeration Date | 08/18/2009
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Last Update Date | 10/13/2023
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Provider Practice Location Address
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Address Line | 482 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5000
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Country | US
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Telephone | 812-333-8474
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Fax | 812-961-3804
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Provider Business Mailing Address
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Address Line | 482 S LANDMARK AVE
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City | BLOOMINGTON
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State | IN
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Zip | 47403-5000
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Country | US
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Telephone | 812-333-8474
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Fax | 812-961-3804
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Authorized Official
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Title or Position | PSYCHOLOGIST/OWNER
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Name | DR. JENNIFER MICHAEL SPENCER
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Credential | PHD HSPP
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Telephone | 812-333-8474
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 20041405
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License Number State | IN
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