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NPI Code Detail

MEDICARE: JULIE CLAIRE SPARE MS

MEDICARE: JULIE CLAIRE SPARE MS
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
1103T00000XPsychologistLP1570MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1484059OTHERVALUE OPTIONS
2966270898002OTHERPREFERED 1
36229151OTHERMNUBH SELECT CARE
4191030OTHERMAYO MANAGEMENT
525556OTHERHEALTH PARTNERS
65581858OTHERMNBCBS

General Provider Information

NPI Number : 1891777496
Entity Type Code : Individual
Provider Name (Legal Business Name) : JULIE CLAIRE SPARE MS
Provider Business Mailing Address
First Line : 600 25TH AVE S
Second Line : #109
City : SAINT CLOUD
State : MN
Zip : 56301-4841
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Provider Business Practice Location Address
First Line : 600 25TH AVE S
Second Line : #109
City : SAINT CLOUD
State : MN
Zip : 56301-4841
Country : US
Telephone Number : 320-255-0343
Fax Number : 320-654-0318
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 07/08/2007

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1508848110 — DR. SUZANNE DAY JAMES PHD LP
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1861477234 — MS. JOANNE AGNES KANE LP
Practice Location Address:
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Practice Fax: 320-654-0318

Directions to “ JULIE CLAIRE SPARE MS” Practice Location

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