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General NPI Number Information
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NPI Number | 1366659005
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Entity Type | Organization
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Legal Business Name | SPEARE & SAMPSON PA
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 225 1ST ST N SUITE 3100
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City | VIRGINIA
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State | MN
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Zip | 55792
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Country | US
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Telephone | 218-741-3740
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Fax |
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Provider Business Mailing Address
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Address Line | 225 1ST ST N SUITE 3100
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City | VIRGINIA
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State | MN
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Zip | 55792
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Country | US
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Telephone | 218-741-3740
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. JONATHAN SPEARE
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Credential | PHD LIC PSYCHOLOGIST
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Telephone | 218-741-3740
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP0655
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP1373
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License Number State | MN
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