Provider Demographics
NPI:1518738608
Name:SPENCER, TAHKEIA MONAY
Entity Type:Individual
Prefix:
First Name:TAHKEIA
Middle Name:MONAY
Last Name:SPENCER
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 1:7921 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-5214
Mailing Address - Country:US
Mailing Address - Phone:708-518-5742
Mailing Address - Fax:
Practice Address - Street 1:737 W WRIGHTWOOD AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-2539
Practice Address - Country:US
Practice Address - Phone:773-672-9815
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician