Provider Demographics
NPI:1003962499
Name:SPENCER, AMY (SLP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:
Other - Last Name:HUNT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS CCC/SLP, LSLS
Mailing Address - Street 1:55 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3734
Mailing Address - Country:US
Mailing Address - Phone:207-776-3585
Mailing Address - Fax:
Practice Address - Street 1:1 MACKWORTH IS
Practice Address - Street 2:
Practice Address - City:FALMOUTH
Practice Address - State:ME
Practice Address - Zip Code:04105-1900
Practice Address - Country:US
Practice Address - Phone:207-749-8133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MESP2114235Z00000X
NH1071235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist