Provider Demographics
NPI:1154962181
Name:SPENNER, CHRISTOPHER
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:SPENNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 EAST POPLAR STREET
Mailing Address - Street 2:
Mailing Address - City:NOBLE
Mailing Address - State:IL
Mailing Address - Zip Code:62868
Mailing Address - Country:US
Mailing Address - Phone:618-388-0165
Mailing Address - Fax:
Practice Address - Street 1:229 EAST POPLAR STREET
Practice Address - Street 2:
Practice Address - City:NOBLE
Practice Address - State:IL
Practice Address - Zip Code:62868
Practice Address - Country:US
Practice Address - Phone:618-388-0165
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-01
Last Update Date:2019-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral