Provider Demographics
NPI:1013478312
Name:SPENCER, SAMIKQUA (APSW)
Entity Type:Individual
Prefix:
First Name:SAMIKQUA
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:APSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1751 S 115TH CT APT 101
Mailing Address - Street 2:
Mailing Address - City:WEST ALLIS
Mailing Address - State:WI
Mailing Address - Zip Code:53214-3779
Mailing Address - Country:US
Mailing Address - Phone:414-573-4584
Mailing Address - Fax:
Practice Address - Street 1:1751 S 115TH CT APT 101
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53214-3779
Practice Address - Country:US
Practice Address - Phone:414-573-4584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI132328-121104100000X
WI18477101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)