MEDICARE: ANDREA 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
1	235Z00000X	Speech-Language Pathologist	24447	TX

General Provider Information

NPI Number	:	1720445976
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA SPENCER

Provider Business Mailing Address
First Line	:	7711 PITTSFORD LN
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76002-4408
Country	:	US
Telephone Number	:	214-207-1683
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 SYCAMORE SCHOOL RD
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76134-5009
Country	:	US
Telephone Number	:	817-293-7610
Fax Number	:

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

Provider Enumeration Date	:	01/19/2016
Last Update Date	:	01/19/2016

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Directions to “ ANDREA SPENCER ” Practice Location

Language	Start Address	Practice Location

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