Basic Information
| Provider Information | |||||||||
| NPI: | 1861523557 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SPANGLER | ||||||||
| FirstName: | LEEANN | ||||||||
| MiddleName: | - | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LADC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 WHITE OAKS LN | ||||||||
| Address2: | |||||||||
| City: | VADNAIS HEIGHTS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551276131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6514868440 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4432 CHICAGO AVE | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554073519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6128710118 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/07/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 300455 | MN | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
ID Information
| ID | Type | State | Issuer | Description | 300455 | 01 | MN | LADC STATE LICENSE | OTHER |