Provider Demographics
NPI:1780984518
Name:SPENCER, LOIS (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LOIS
Middle Name:
Last Name:SPENCER
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2647 PAUL AVE NW
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30318-1136
Mailing Address - Country:US
Mailing Address - Phone:404-983-3529
Mailing Address - Fax:404-799-9128
Practice Address - Street 1:2647 PAUL AVE NW
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30318-1136
Practice Address - Country:US
Practice Address - Phone:404-983-3529
Practice Address - Fax:404-799-9128
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-27
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA006157235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist