Provider Demographics
NPI:1760852321
Name:SPENCER, RIKKI MAGDALENE BAER (PSYD)
Entity Type:Individual
Prefix:
First Name:RIKKI MAGDALENE
Middle Name:BAER
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:RIKKI
Other - Middle Name:SPENCER
Other - Last Name:PASHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:624 DIAMOND ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2444
Mailing Address - Country:US
Mailing Address - Phone:747-258-0280
Mailing Address - Fax:
Practice Address - Street 1:624 DIAMOND ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-2444
Practice Address - Country:US
Practice Address - Phone:747-258-0280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-25
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10201103TC0700X
CA29477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical