Individual
WESLEY DANIEL SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
90 E 200 N, LOGAN, UT 84321-4034
(435) 752-0750
Mailing address
405 EDGEWOOD DR, PROVIDENCE, UT 84332-9471
(435) 750-6118
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
4803198-2501
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
107003178101
IHC PROVIDER NETWORK
UT
01
—
70578
PEHP
UT
01
—
870401386SP1
EMIA
UT
Enumeration date
09/13/2006
Last updated
07/08/2007
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