Individual
DR. SPENCER JENKINS BOOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PSYD, HSPP
Contact information
Practice address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 417-4885
Mailing address
9329 ILLINOIS RD, FORT WAYNE, IN 46804-5796
(260) 417-4885
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20041340A
IN
103TM1800X
Intellectual & Developmental Disabilities Psychologist
—
—
Other
Enumeration date
08/26/2010
Last updated
10/01/2024
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