Provider Demographics
NPI:1639520695
Name:SPENCER, JESSICA (EDD, CAP, CPP)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:EDD, CAP, CPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 8TH AVE W
Mailing Address - Street 2:SUITE 303
Mailing Address - City:PALMETTO
Mailing Address - State:FL
Mailing Address - Zip Code:34221-5168
Mailing Address - Country:US
Mailing Address - Phone:941-722-2747
Mailing Address - Fax:
Practice Address - Street 1:600 8TH AVE W
Practice Address - Street 2:SUITE 303
Practice Address - City:PALMETTO
Practice Address - State:FL
Practice Address - Zip Code:34221-5168
Practice Address - Country:US
Practice Address - Phone:941-722-2747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-30
Last Update Date:2016-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)