MEDICARE: DR. PENNY L. SPRECHER PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	0810001349	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1366475634
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PENNY L. SPRECHER PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 1482
Second Line	:
City	:	CHESTERFIELD
State	:	VA
Zip	:	23832-9104
Country	:	US
Telephone Number	:	804-768-0295
Fax Number	:	804-717-5269

Provider Business Practice Location Address
First Line	:	12801 IRON BRIDGE RD
Second Line	:	SUITE 400
City	:	CHESTER
State	:	VA
Zip	:	23831-1669
Country	:	US
Telephone Number	:	804-768-0295
Fax Number	:	804-717-5269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	07/23/2012

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