Provider Demographics
NPI:1912059437
Name:SPENCER, JESSICA LYNN
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LYNN
Last Name:SPENCER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 WISE LN
Mailing Address - Street 2:
Mailing Address - City:MC CONNELSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43756-9122
Mailing Address - Country:US
Mailing Address - Phone:740-962-4474
Mailing Address - Fax:
Practice Address - Street 1:3500 WISE LN
Practice Address - Street 2:
Practice Address - City:MC CONNELSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43756-9122
Practice Address - Country:US
Practice Address - Phone:740-962-4474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2218184Medicaid