Provider Demographics
NPI:1093391385
Name:SPENCER SPEECH THERAPY
Entity Type:Organization
Organization Name:SPENCER SPEECH THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH-LANGUAGE PATHOLOGIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SPENCER
Authorized Official - Middle Name:TOWNSEND
Authorized Official - Last Name:SHUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:CCC-SLP
Authorized Official - Phone:828-773-9195
Mailing Address - Street 1:PO BOX 252
Mailing Address - Street 2:
Mailing Address - City:DEEP GAP
Mailing Address - State:NC
Mailing Address - Zip Code:28618-0252
Mailing Address - Country:US
Mailing Address - Phone:828-773-9195
Mailing Address - Fax:844-906-2433
Practice Address - Street 1:245 WINKLERS CREEK RD STE C
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-7838
Practice Address - Country:US
Practice Address - Phone:828-773-9195
Practice Address - Fax:844-906-2433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1205496163OtherWELL CARE
NC1205496163OtherOPTUM HEALTH
NC1205496163OtherBLUE CROSS BLUE SHIELD NC
NC1205496163Medicaid