Provider Demographics
NPI:1417225913
Name:SPARTZ, REBECCA DIANE (LICSW)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:SPARTZ
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 1:2829 UNIVERSITY AVE SE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55414-3230
Mailing Address - Country:US
Mailing Address - Phone:612-767-2165
Mailing Address - Fax:
Practice Address - Street 1:4029 14TH AVE S
Practice Address - Street 2:#18G
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-3200
Practice Address - Country:US
Practice Address - Phone:612-618-6259
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN134651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical