Provider Demographics
NPI:1841069887
Name:SPENCER, CARSON PRATT (HIS)
Entity type:Individual
Prefix:
First Name:CARSON
Middle Name:PRATT
Last Name:SPENCER
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 1:5510 SW 5TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73128-1216
Mailing Address - Country:US
Mailing Address - Phone:405-898-6699
Mailing Address - Fax:
Practice Address - Street 1:5510 SW 5TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73128-1216
Practice Address - Country:US
Practice Address - Phone:405-898-6699
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-01
Last Update Date:2024-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1201237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist