Provider Demographics
NPI:1316750987
Name:WARD, SPENCER JAMES
Entity type:Individual
Prefix:
First Name:SPENCER
Middle Name:JAMES
Last Name:WARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:SPENCER
Other - Middle Name:JAMES
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:7108 SOUTH KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16280 BESSIE CT
Practice Address - Street 2:
Practice Address - City:LA PINE
Practice Address - State:OR
Practice Address - Zip Code:97739-9637
Practice Address - Country:US
Practice Address - Phone:541-213-7899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician