Provider Demographics
NPI:1023561784
Name:SPENCER, TERESA L (MA, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERESA
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1424 N STONEY POINT ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-1270
Mailing Address - Country:US
Mailing Address - Phone:316-250-5476
Mailing Address - Fax:
Practice Address - Street 1:1424 N STONEY POINT ST # 1270
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1270
Practice Address - Country:US
Practice Address - Phone:316-721-6549
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1018235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist