Basic Information
| Provider Information | |||||||||
| NPI: | 1083098750 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPENCE | ||||||||
| FirstName: | DIONNE | ||||||||
| MiddleName: | MASHAWN | ||||||||
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| Credential: | MA SLP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2128 WINTHROP CHASE DR | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 28212 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043510692 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 16455 STATESVILLE RD | ||||||||
| Address2: | |||||||||
| City: | HUNTERSVILLE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 280787135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7048013719 | ||||||||
| FaxNumber: | 7048013705 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2015 | ||||||||
| LastUpdateDate: | 07/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 1602223 | NC | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.