Provider Demographics
NPI:1780185694
Name:SPENCER, ROBIN (CPED)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CPED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 E WOODFIELD RD STE 555
Mailing Address - Street 2:
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60173-5153
Mailing Address - Country:US
Mailing Address - Phone:847-619-1701
Mailing Address - Fax:847-619-1702
Practice Address - Street 1:1710 E WOODFIELD RD STE 555
Practice Address - Street 2:
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60173-5153
Practice Address - Country:US
Practice Address - Phone:847-619-1701
Practice Address - Fax:847-619-1702
Is Sole Proprietor?:No
Enumeration Date:2018-02-26
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL212.000040224L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224L00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPedorthist