Provider Demographics
NPI:1366475634
Name:SPRECHER, PENNY L (PHD)
Entity Type:Individual
Prefix:DR
First Name:PENNY
Middle Name:L
Last Name:SPRECHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1482
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23832-9104
Mailing Address - Country:US
Mailing Address - Phone:804-768-0295
Mailing Address - Fax:804-717-5269
Practice Address - Street 1:12801 IRON BRIDGE RD
Practice Address - Street 2:SUITE 400
Practice Address - City:CHESTER
Practice Address - State:VA
Practice Address - Zip Code:23831-1669
Practice Address - Country:US
Practice Address - Phone:804-768-0295
Practice Address - Fax:804-717-5269
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810001349103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA7799349Medicaid
VA7799349Medicaid
VA620000156Medicare PIN