Provider Demographics
NPI:1235819632
Name:SPENCE, LASHONDA L (COSMETOLOGIST)
Entity Type:Individual
Prefix:
First Name:LASHONDA
Middle Name:L
Last Name:SPENCE
Suffix:
Gender:F
Credentials:COSMETOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:933 TRAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:DESOTO
Mailing Address - State:TX
Mailing Address - Zip Code:75115-5546
Mailing Address - Country:US
Mailing Address - Phone:469-835-9926
Mailing Address - Fax:
Practice Address - Street 1:111 CEDAR RIDGE DR
Practice Address - Street 2:SUITE 101 ROOM 12
Practice Address - City:DUNCANVILLE
Practice Address - State:TX
Practice Address - Zip Code:75116
Practice Address - Country:US
Practice Address - Phone:469-835-9266
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-20
Last Update Date:2023-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
335E00000X
TX1143976225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
No335E00000XSuppliersProsthetic/Orthotic Supplier