Provider Demographics
NPI:1710669668
Name:SPENCER, JALEN
Entity Type:Individual
Prefix:
First Name:JALEN
Middle Name:
Last Name:SPENCER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 FERRAND ST STE 1
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3255
Mailing Address - Country:US
Mailing Address - Phone:318-372-0072
Mailing Address - Fax:
Practice Address - Street 1:2414 FERRAND ST STE 1
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-3255
Practice Address - Country:US
Practice Address - Phone:318-372-0072
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator