Healthcare Provider Details

I. General information

NPI: 1316123722
Provider Name (Legal Business Name): LYNDA SPANGLER MSW, LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2008
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 SE 6TH ST SUITE 311
GRANTS PASS OR
97526-2404
US

IV. Provider business mailing address

PO BOX 1831
GRANTS PASS OR
97528-0156
US

V. Phone/Fax

Practice location:
  • Phone: 541-761-6727
  • Fax: 541-476-9087
Mailing address:
  • Phone: 541-761-6727
  • Fax: 541-476-9087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL1992
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: