Provider Demographics
NPI:1508999160
Name:SPISAK, MEADOW PROMISE (BS)
Entity Type:Individual
Prefix:MISS
First Name:MEADOW
Middle Name:PROMISE
Last Name:SPISAK
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 S WADSWORTH BLVD APT 10-210
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80123-1380
Mailing Address - Country:US
Mailing Address - Phone:303-347-6435
Mailing Address - Fax:303-703-3535
Practice Address - Street 1:5500 S SYCAMORE ST
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8201
Practice Address - Country:US
Practice Address - Phone:303-347-6435
Practice Address - Fax:303-703-3535
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health