Tara V Spevack, PH.D., ABPP-CN

Primary specialty

Clinical NeuropsychologistTaxonomy code 103G00000X

License

1999135246 Issued in MO

Practice address

1 Childrens PL
#3S32
Saint Louis, MO 63110-1002

Phone

(314) 454-6069

Fax

(314) 454-4576

NPI assigned

Jul 16, 2006

Last updated

Jul 16, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1153008000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1184544000000",
    "number": "1588681472",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PL",
            "address_2": "#3S32",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101002",
            "telephone_number": "314-454-6069",
            "fax_number": "314-454-4576"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1 CHILDRENS PL",
            "address_2": "#3S32",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631101002",
            "telephone_number": "314-454-6069",
            "fax_number": "314-454-4576"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPEVACK",
        "first_name": "TARA",
        "middle_name": "V",
        "name_prefix": "Dr.",
        "credential": "PH.D., ABPP-CN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-07-16",
        "last_updated": "2007-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "MO",
            "license": "1999135246",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UBH",
            "identifier": "255873",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "138995",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Monica Sharee Spencer
• Monique Robertson Spencer
• Robert Michael Spencer
• William Daniel Spencer, M.S.
• Yvette Spencer, CSW
• Robert D Spewak, MD
• Michael J Spezia, D.O.
• Giovanni Speziali, M.D.
• Sphere Medical Group
• Rose Marie Spicer

• Clinical Neuropsychologist in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Clinical Neuropsychologist in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2007; 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.