Provider Demographics
NPI:1609085646
Name:SPICER, KAY ELLEN (CSAC-ICS, SAP, IDP-A)
Entity Type:Individual
Prefix:MS
First Name:KAY
Middle Name:ELLEN
Last Name:SPICER
Suffix:
Gender:F
Credentials:CSAC-ICS, SAP, IDP-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 W PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:WI
Mailing Address - Zip Code:53901-1927
Mailing Address - Country:US
Mailing Address - Phone:608-742-2280
Mailing Address - Fax:
Practice Address - Street 1:449 HITCHCOCK ST
Practice Address - Street 2:
Practice Address - City:BARABOO
Practice Address - State:WI
Practice Address - Zip Code:53913-2876
Practice Address - Country:US
Practice Address - Phone:608-355-4106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1842 AND 111859101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)