Provider Demographics
NPI:1700546157
Name:ERDMAN, SPENCER PATRICK (MA-SLP)
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:PATRICK
Last Name:ERDMAN
Suffix:
Gender:M
Credentials:MA-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1944 BUTTRICK AVE SE
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:MI
Mailing Address - Zip Code:49301-9204
Mailing Address - Country:US
Mailing Address - Phone:616-799-1593
Mailing Address - Fax:
Practice Address - Street 1:2060 HEALTH DR SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9687
Practice Address - Country:US
Practice Address - Phone:616-333-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-27
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist