Provider Demographics
NPI:1720188600
Name:SPJUT, DENNIS U (PHD)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:U
Last Name:SPJUT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:732 E JEFFERSON ST
Mailing Address - Street 2:DENNIS SPJUT PHD
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37760
Mailing Address - Country:US
Mailing Address - Phone:865-475-8631
Mailing Address - Fax:865-475-8631
Practice Address - Street 1:732 E JEFFERSON ST
Practice Address - Street 2:DENNIS SPJUT PHD
Practice Address - City:JEFFERSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37760
Practice Address - Country:US
Practice Address - Phone:865-475-8631
Practice Address - Fax:865-475-8631
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0256103TC0700X
KY00197103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3680876Medicare ID - Type Unspecified
KYCP00167Medicare ID - Type Unspecified