Provider Demographics
NPI:1558332817
Name:SPENCER, SUSAN (EDD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1998 EASTWOOD CT
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46017-9689
Mailing Address - Country:US
Mailing Address - Phone:765-378-7306
Mailing Address - Fax:765-378-7306
Practice Address - Street 1:1 PLAZA DR
Practice Address - Street 2:SUITE 6
Practice Address - City:PENDLETON
Practice Address - State:IN
Practice Address - Zip Code:46064-8823
Practice Address - Country:US
Practice Address - Phone:765-778-0380
Practice Address - Fax:765-778-8328
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040523A103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN509620AMedicare ID - Type Unspecified