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NPI Code Detail

MEDICARE: MS. LEEANN - SPANGLER LADC

MEDICARE: MS. LEEANN - SPANGLER LADC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YA0400XAddiction (Substance Use Disorder) Counselor300455MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1300455OTHERMNLADC STATE LICENSE

General Provider Information

NPI Number : 1861523557
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. LEEANN - SPANGLER LADC
Provider Business Mailing Address
First Line : 155 WHITE OAKS LN
Second Line :
City : VADNAIS HEIGHTS
State : MN
Zip : 55127-6131
Country : US
Telephone Number : 651-486-8440
Fax Number :
Provider Business Practice Location Address
First Line : 4432 CHICAGO AVE
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55407-3519
Country : US
Telephone Number : 612-871-0118
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2007
Last Update Date : 07/08/2007

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