Provider Demographics
NPI:1508121757
Name:SPANJERS, HOLLY (LADC)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:
Last Name:SPANJERS
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:HOLLY
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1132 CENTRAL AVE NE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-1512
Mailing Address - Country:US
Mailing Address - Phone:612-902-5914
Mailing Address - Fax:
Practice Address - Street 1:1132 CENTRAL AVE NE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55413-1512
Practice Address - Country:US
Practice Address - Phone:612-902-5914
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN302673101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)