Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 336939 | MO |
NPI | 1033565254 |
---|---|
Provider Name | Erica Spencer |
First Address | Saint Louis, MO 63146-3209 |
Second Address | Saint Louis, MO 63146-3209 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/05/2016 |
Last Update Date | 05/05/2016 |