Provider Demographics
NPI:1417470717
Name:SPENCER-CANTON, BETHESDA
Entity type:Individual
Prefix:MS
First Name:BETHESDA
Middle Name:
Last Name:SPENCER-CANTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JOSHUA
Other - Middle Name:CHANDLER
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:909 N BEECH ST UNIT 208
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1260
Mailing Address - Country:US
Mailing Address - Phone:801-558-5242
Mailing Address - Fax:
Practice Address - Street 1:909 N BEECH ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1198
Practice Address - Country:US
Practice Address - Phone:801-558-5242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-19
Last Update Date:2024-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORBAP-E-10228120174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty