Provider Demographics
NPI:1952757585
Name:SPENCER, SARAH VANSELOUS (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:VANSELOUS
Last Name:SPENCER
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:
Other - Last Name:VANSELOUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1875 CENTURY BLVD NE STE 200
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30345-3314
Mailing Address - Country:US
Mailing Address - Phone:404-633-8911
Mailing Address - Fax:404-633-6403
Practice Address - Street 1:277 MARTIN LUTHER KING JR BLVD STE 104
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31201-3476
Practice Address - Country:US
Practice Address - Phone:478-741-0019
Practice Address - Fax:478-742-1308
Is Sole Proprietor?:No
Enumeration Date:2016-05-12
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist