Provider Demographics
NPI:1902560295
Name:SPENCER, ALYSSA L (LMSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:L
Last Name:SPENCER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:
Other - Last Name:SPENCER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:555 N WOODLAWN ST STE 3105
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-3673
Mailing Address - Country:US
Mailing Address - Phone:182-131-6685
Mailing Address - Fax:
Practice Address - Street 1:555 N WOODLAWN ST STE 3105
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3673
Practice Address - Country:US
Practice Address - Phone:182-131-6685
Practice Address - Fax:316-652-2595
Is Sole Proprietor?:No
Enumeration Date:2021-10-24
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12334104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker