Provider Demographics
NPI:1326103847
Name:SPOONER, DIONNE L (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DIONNE
Middle Name:L
Last Name:SPOONER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28883 N 131ST DR
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-4294
Mailing Address - Country:US
Mailing Address - Phone:701-721-8978
Mailing Address - Fax:
Practice Address - Street 1:28883 N 131ST DR
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-4294
Practice Address - Country:US
Practice Address - Phone:701-721-8978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2023-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND3018104100000X, 1041C0700X
AZLCSW-193951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ130102Medicaid
ND26353OtherBLUE SHIELD
ND74019Medicaid