Provider Demographics
NPI:1093235509
Name:SPICER, MERCEDES
Entity type:Individual
Prefix:
First Name:MERCEDES
Middle Name:
Last Name:SPICER
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3101 LATHAM DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53713-4613
Mailing Address - Country:US
Mailing Address - Phone:608-286-1132
Mailing Address - Fax:608-440-2954
Practice Address - Street 1:941 SOUTH ST
Practice Address - Street 2:
Practice Address - City:DEFOREST
Practice Address - State:WI
Practice Address - Zip Code:53532-1403
Practice Address - Country:US
Practice Address - Phone:608-772-0797
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-26
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI121461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical