Provider Demographics
NPI:1932288040
Name:SPENCER, CRISTINA NICOLE (MA CCC SLPL)
Entity Type:Individual
Prefix:MRS
First Name:CRISTINA
Middle Name:NICOLE
Last Name:SPENCER
Suffix:
Gender:M
Credentials:MA CCC SLPL
Other - Prefix:MS
Other - First Name:CRISTINA
Other - Middle Name:NICOLE
Other - Last Name:PESCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA CCC SLPL
Mailing Address - Street 1:3250 PLAYERS CLUB PARKWAY
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38125
Mailing Address - Country:US
Mailing Address - Phone:901-685-7227
Mailing Address - Fax:
Practice Address - Street 1:18 N CATHERINE
Practice Address - Street 2:
Practice Address - City:LA GRANGE
Practice Address - State:IL
Practice Address - Zip Code:60525
Practice Address - Country:US
Practice Address - Phone:708-482-9453
Practice Address - Fax:708-482-9454
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL12411721235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist