Provider Demographics
NPI:1134653587
Name:SPOONER, JACQULIN
Entity Type:Individual
Prefix:
First Name:JACQULIN
Middle Name:
Last Name:SPOONER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 MOCKINGBIRD ST
Mailing Address - Street 2:
Mailing Address - City:SAINT ROSE
Mailing Address - State:LA
Mailing Address - Zip Code:70087-3819
Mailing Address - Country:US
Mailing Address - Phone:504-338-4334
Mailing Address - Fax:985-651-4613
Practice Address - Street 1:713 MOCKINGBIRD ST
Practice Address - Street 2:
Practice Address - City:SAINT ROSE
Practice Address - State:LA
Practice Address - Zip Code:70087-3819
Practice Address - Country:US
Practice Address - Phone:504-338-4334
Practice Address - Fax:985-651-4613
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-12
Last Update Date:2017-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health