Provider Demographics
NPI:1588809628
Name:SPENCER, LAURIE JEANNE (CNMT)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:JEANNE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CNMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:637 PINE DR
Mailing Address - Street 2:
Mailing Address - City:GUFFEY
Mailing Address - State:CO
Mailing Address - Zip Code:80820-9660
Mailing Address - Country:US
Mailing Address - Phone:719-641-1557
Mailing Address - Fax:
Practice Address - Street 1:320 BURDETTE ST
Practice Address - Street 2:SUITE A
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-2435
Practice Address - Country:US
Practice Address - Phone:719-641-1557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist