Individual
DR. BRENDA H. SPENCE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
201 S. DIVISION ST., BRISTOL, IN 46507-0275
(574) 848-0347
(574) 848-5231
Mailing address
PO BOX 756, BRISTOL, IN 46507-0756
(574) 848-7305
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
20040650
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
181900
MEDICARE PTAN
IN
05
—
20033927A
—
IN
Enumeration date
06/30/2006
Last updated
11/21/2009
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