Provider Demographics
NPI:1912745597
Name:SPICER, ANDREA DENISE
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:DENISE
Last Name:SPICER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20930 GOLLER AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44119-1849
Mailing Address - Country:US
Mailing Address - Phone:216-235-9938
Mailing Address - Fax:
Practice Address - Street 1:20930 GOLLER AVE
Practice Address - Street 2:
Practice Address - City:EUCLID
Practice Address - State:OH
Practice Address - Zip Code:44119-1849
Practice Address - Country:US
Practice Address - Phone:216-235-9938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-17
Last Update Date:2024-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services