Provider Demographics
NPI:1578097820
Name:SPENCER, KATIE LYNN (LISW)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:
Other - Last Name:ARRINGTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4600 MONTGOMERY RD STE 400
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2600
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:201 N YELLOW SPRINGS ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45504-2650
Practice Address - Country:US
Practice Address - Phone:833-510-4357
Practice Address - Fax:866-459-6532
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-13
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2002037-SUPV104100000X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker