Provider Demographics
NPI:1326809088
Name:SPALDING, MADELEINE (LADC)
Entity Type:Individual
Prefix:
First Name:MADELEINE
Middle Name:
Last Name:SPALDING
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11605 28TH AVE N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-3023
Mailing Address - Country:US
Mailing Address - Phone:320-291-4430
Mailing Address - Fax:
Practice Address - Street 1:8085 WAYZATA BLVD STE 203
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55426-1461
Practice Address - Country:US
Practice Address - Phone:612-296-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-19
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN306388101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)