MEDICARE: DANIEL JOSEPH SPENCER IV CADC

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
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	CAC8913	ME

General Provider Information

NPI Number	:	1245178656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DANIEL JOSEPH SPENCER IV CADC

Provider Business Mailing Address
First Line	:	475 E 4140 S APT 34
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-1720
Country	:	US
Telephone Number	:	585-333-6384
Fax Number	:

Provider Business Practice Location Address
First Line	:	475 E 4140 S APT 34
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84107-1720
Country	:	US
Telephone Number	:	585-333-6384
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2026
Last Update Date	:	03/24/2026

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