Provider Demographics
NPI:1023435914
Name:SPENCER, MARQUISHA SHANAE
Entity type:Individual
Prefix:
First Name:MARQUISHA
Middle Name:SHANAE
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6625 EVANS ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3210
Mailing Address - Country:US
Mailing Address - Phone:402-763-7449
Mailing Address - Fax:
Practice Address - Street 1:6625 EVANS ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3210
Practice Address - Country:US
Practice Address - Phone:402-763-7449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-28
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor