Basic Information
| Provider Information | |||||||||
| NPI: | 1972630648 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SPENCER | ||||||||
| FirstName: | DEBRA | ||||||||
| MiddleName: | HELEN | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | MS CCC-A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 KNOLLS RD | ||||||||
| Address2: | |||||||||
| City: | WALLKILL | ||||||||
| State: | NY | ||||||||
| PostalCode: | 125893622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8458958810 | ||||||||
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| Practice Location | |||||||||
| Address1: | 162 E BROADWAY | ||||||||
| Address2: | |||||||||
| City: | MONTICELLO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 127018815 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457961350 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/28/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 231H00000X | 0018671 | NY | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.