=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598282477
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA LYNN SPICER
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/23/2017
-----------------------------------------------------
Last Update Date | 03/15/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 620 BABCOCK BLVD E
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55328-8603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-568-6161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 372 GREENWAY DR
-----------------------------------------------------
City | DELANO
-----------------------------------------------------
State | MN
-----------------------------------------------------
Zip | 55328-4571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 612-568-6161
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 02222
-----------------------------------------------------
License Number State | MN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------