Provider Demographics
NPI:1164723417
Name:SPENCER, JENNIFER (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2272 W 95TH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-8942
Mailing Address - Country:US
Mailing Address - Phone:630-409-9700
Mailing Address - Fax:630-409-9444
Practice Address - Street 1:2272 W 95TH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-8942
Practice Address - Country:US
Practice Address - Phone:630-409-9700
Practice Address - Fax:630-409-9444
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2010-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071006284103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical