Provider Demographics
NPI:1295460962
Name:SPICER, JENSEN CIARA
Entity Type:Individual
Prefix:
First Name:JENSEN
Middle Name:CIARA
Last Name:SPICER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N 5TH ST
Mailing Address - Street 2:
Mailing Address - City:COLEMAN
Mailing Address - State:MI
Mailing Address - Zip Code:48618-9327
Mailing Address - Country:US
Mailing Address - Phone:989-513-6268
Mailing Address - Fax:
Practice Address - Street 1:118 E SUPERIOR ST
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1817
Practice Address - Country:US
Practice Address - Phone:989-285-1660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other