Provider Demographics
NPI:1316679145
Name:SPENCER, GRETCHEN ELIZABETH (AUD)
Entity type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:SPENCER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 S HILL ISLAND RD
Mailing Address - Street 2:
Mailing Address - City:CEDARVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49719-9488
Mailing Address - Country:US
Mailing Address - Phone:906-440-3362
Mailing Address - Fax:
Practice Address - Street 1:1900 E MAIN ST
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:IL
Practice Address - Zip Code:61832-5100
Practice Address - Country:US
Practice Address - Phone:906-440-3362
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHA.02386231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist