Spencer Park

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LW60761384 Issued in WA

Practice address

1601 E Fourth Plain Blvd
Vancouver, WA 98661-3713

Phone

(360) 696-4061

NPI assigned

Aug 31, 2011

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1553558400000",
    "number": "1376824649",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 3RD ST",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941071214"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1601 E FOURTH PLAIN BLVD",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986613713",
            "telephone_number": "360-696-4061"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PARK",
        "first_name": "SPENCER",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2011-08-31",
        "last_updated": "2019-03-26",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS28457",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "WA",
            "license": "LW60761384",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jennifer Park
• Kye Soo Park, MD
• Lina Park
• Lydia S. Park, D.O.
• Sandria Park
• Stephanie Jihyun Park
• Subin Park
• Yon Joo Park, M.D.
• Aaron Butch Parker, M.D.
• Alissa Cottle Parker

• Clinical Social Worker in Vancouver, WA
• Providers in Vancouver, WA by specialty
• Clinical Social Worker in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 26, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.