Provider Demographics
NPI:1285962365
Name:SPENCER, AMY RUTH (LAC, MACOM)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RUTH
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LAC, MACOM
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:RUTH
Other - Last Name:STELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LAC, MACOM
Mailing Address - Street 1:10365 SE SUNNYSIDE RD.
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CLACKAMAS
Mailing Address - State:OR
Mailing Address - Zip Code:97015
Mailing Address - Country:US
Mailing Address - Phone:503-887-7725
Mailing Address - Fax:503-855-3269
Practice Address - Street 1:15240 SE 82ND DR
Practice Address - Street 2:
Practice Address - City:CLACKAMAS
Practice Address - State:OR
Practice Address - Zip Code:97015-9606
Practice Address - Country:US
Practice Address - Phone:503-656-5510
Practice Address - Fax:503-656-8080
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-30
Last Update Date:2015-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC150496171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist