Provider Demographics
NPI:1609280411
Name:VERONIKA SPICER LLC
Entity Type:Organization
Organization Name:VERONIKA SPICER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VERONIKA
Authorized Official - Middle Name:KARPENKO
Authorized Official - Last Name:SPICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-801-9467
Mailing Address - Street 1:836 W. SOUTH BOUNDARY
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43511
Mailing Address - Country:US
Mailing Address - Phone:419-874-3201
Mailing Address - Fax:419-874-1989
Practice Address - Street 1:836 W SOUTH BOUNDARY ST
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5640
Practice Address - Country:US
Practice Address - Phone:419-874-3201
Practice Address - Fax:419-874-1989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-19
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7292172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes172V00000XOther Service ProvidersCommunity Health WorkerGroup - Single Specialty