MEDICARE: RENA 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	7101001694	MI

General Provider Information

NPI Number	:	1942639422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENA SPENCER

Provider Business Mailing Address
First Line	:	5208 LIBERTY DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-9737
Country	:	US
Telephone Number	:	231-357-4515
Fax Number	:

Provider Business Practice Location Address
First Line	:	5208 LIBERTY DR
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49685-9737
Country	:	US
Telephone Number	:	231-357-4515
Fax Number	:

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

Provider Enumeration Date	:	11/05/2013
Last Update Date	:	11/05/2013

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Directions to “ RENA SPENCER ” Practice Location

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