Provider Information for 1780101188
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Ms. DANIELLE RAE SPOLARICH LPC, LADC
Sex: Female
NPI: 1780101188
Last Updated: 2017-08-25
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1780101188 | ||||||||||||
| Enumeration Date | 2017-08-25 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | NO | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 505 S 12TH AVE W VIRGINIA, MN 55792-3099 United States Phone: 12187492877127 | Fax:218-749-6033 | ||||||||||||
| Primary Practice Address | 505 S 12TH AVE W VIRGINIA, MN 55792-3099 United States Phone: 12187492877127 | Fax:218-749-6033 | ||||||||||||
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