Provider Demographics
NPI:1073845079
Name:SPENCER, KATHERINE G (PHD)
Entity type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:G
Last Name:SPENCER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 S 2ND ST
Mailing Address - Street 2:SUITE 180
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55454-1075
Mailing Address - Country:US
Mailing Address - Phone:612-626-8755
Mailing Address - Fax:
Practice Address - Street 1:1300 S 2ND ST
Practice Address - Street 2:SUITE 180
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1075
Practice Address - Country:US
Practice Address - Phone:612-626-8755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP5221103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical