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NPI Code Detail

MEDICARE: JESSICA SPENCER

MEDICARE: JESSICA SPENCER
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1679964522
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSICA SPENCER
Provider Business Mailing Address
First Line : 2301 VIENNA RD APT A
Second Line :
City : ROLLA
State : MO
Zip : 65401-5105
Country : US
Telephone Number : 801-900-4498
Fax Number :
Provider Business Practice Location Address
First Line : 13160 COUNTY ROAD 3610
Second Line :
City : SAINT JAMES
State : MO
Zip : 65559-9151
Country : US
Telephone Number : 573-899-7149
Fax Number : 573-265-8320
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2015
Last Update Date : 10/07/2016

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Directions to “ JESSICA SPENCER ” Practice Location

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