MEDICARE: LOIS SPENCER CCC-SLP

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	006157	GA

General Provider Information

NPI Number	:	1780984518
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOIS SPENCER CCC-SLP

Provider Business Mailing Address
First Line	:	2647 PAUL AVE NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-1136
Country	:	US
Telephone Number	:	404-983-3529
Fax Number	:	404-799-9128

Provider Business Practice Location Address
First Line	:	2647 PAUL AVE NW
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30318-1136
Country	:	US
Telephone Number	:	404-983-3529
Fax Number	:	404-799-9128

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

Provider Enumeration Date	:	10/27/2010
Last Update Date	:	10/27/2010

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Directions to “ LOIS SPENCER CCC-SLP” Practice Location

Language	Start Address	Practice Location

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