Provider Demographics
NPI:1710282801
Name:SPENCER, HEATHER A (LSCSW, LMAC, CHT)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:A
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LSCSW, LMAC, CHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9415 E HARRY ST STE 503
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5082
Mailing Address - Country:US
Mailing Address - Phone:316-573-7343
Mailing Address - Fax:316-221-7159
Practice Address - Street 1:9415 E HARRY ST STE 208
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5076
Practice Address - Country:US
Practice Address - Phone:316-573-7343
Practice Address - Fax:316-221-7159
Is Sole Proprietor?:No
Enumeration Date:2011-01-20
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS50111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201355360AMedicaid
KS200689770CMedicaid