Provider Demographics
NPI:1043867443
Name:SPENCER, LYNNE WEINER (RN, LLP)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:WEINER
Last Name:SPENCER
Suffix:
Gender:F
Credentials:RN, LLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 W MIDDLE ST STE H
Mailing Address - Street 2:
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1647
Mailing Address - Country:US
Mailing Address - Phone:734-719-0380
Mailing Address - Fax:
Practice Address - Street 1:134 W MIDDLE ST STE H
Practice Address - Street 2:
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1647
Practice Address - Country:US
Practice Address - Phone:734-719-0380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-20
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301011478103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist