Provider Demographics
NPI:1457933046
Name:BERNATT, SPENCER WARREN (HIS)
Entity Type:Individual
Prefix:
First Name:SPENCER
Middle Name:WARREN
Last Name:BERNATT
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 SARATOGA ST UNIT 158
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-7577
Mailing Address - Country:US
Mailing Address - Phone:510-418-5480
Mailing Address - Fax:
Practice Address - Street 1:2350 SARATOGA ST UNIT 158
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-7577
Practice Address - Country:US
Practice Address - Phone:510-418-5480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-23
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA8748237700000X
237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist