Provider Demographics
NPI:1568132066
Name:SPENCER, NICOLE (SLPA)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3776 PATUXENT RIVER RD
Mailing Address - Street 2:
Mailing Address - City:DAVIDSONVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21035-2419
Mailing Address - Country:US
Mailing Address - Phone:202-569-4189
Mailing Address - Fax:
Practice Address - Street 1:3776 PATUXENT RIVER RD
Practice Address - Street 2:
Practice Address - City:DAVIDSONVILLE
Practice Address - State:MD
Practice Address - Zip Code:21035-2419
Practice Address - Country:US
Practice Address - Phone:443-808-1218
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00085L2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant