Provider Demographics
NPI:1922131515
Name:SPENCE, TAMARA J (MS CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:J
Last Name:SPENCE
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2994
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98807-2994
Mailing Address - Country:US
Mailing Address - Phone:509-888-3062
Mailing Address - Fax:509-888-3063
Practice Address - Street 1:524 W INDIANA AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-4721
Practice Address - Country:US
Practice Address - Phone:509-435-0481
Practice Address - Fax:509-435-0485
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00004170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8447021Medicaid