Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 20041405A | IN |
NPI | 1003828880 |
---|---|
Provider Name | Dr. Jennifer Michael Spencer |
First Address | Bloomington, IN 47404-1384 |
Second Address | Bloomington, IN 47404-3871 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
P13825 | (02) | IN |