Healthcare Provider Details

I. General information

NPI: 1043178098
Provider Name (Legal Business Name): DANIEL SPAULDING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15251 PLEASANT VALLEY RD
CENTER CITY MN
55012-9640
US

IV. Provider business mailing address

15251 PLEASANT VALLEY RD
CENTER CITY MN
55012-9640
US

V. Phone/Fax

Practice location:
  • Phone: 800-257-7800
  • Fax: 651-213-4547
Mailing address:
  • Phone: 800-257-7800
  • Fax: 651-213-4547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number307646
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: