Provider Demographics
NPI:1720976061
Name:SPENCER-BENSON, JASMINE LEE
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:LEE
Last Name:SPENCER-BENSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JASMINE
Other - Middle Name:LEE
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:351 BORDEAUX ST
Mailing Address - Street 2:
Mailing Address - City:CHADRON
Mailing Address - State:NE
Mailing Address - Zip Code:69337-2307
Mailing Address - Country:US
Mailing Address - Phone:308-430-8677
Mailing Address - Fax:
Practice Address - Street 1:5789 HIGHWAY 20
Practice Address - Street 2:
Practice Address - City:CHADRON
Practice Address - State:NE
Practice Address - Zip Code:69337-7349
Practice Address - Country:US
Practice Address - Phone:308-432-4050
Practice Address - Fax:308-432-3992
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-25
Last Update Date:2025-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker