Provider Demographics
NPI:1679024921
Name:SPANGLER, LAYNE
Entity Type:Individual
Prefix:
First Name:LAYNE
Middle Name:
Last Name:SPANGLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LAYNE
Other - Middle Name:
Other - Last Name:SPANGLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RADT11
Mailing Address - Street 1:431 44TH AVE
Mailing Address - Street 2:203
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1469
Mailing Address - Country:US
Mailing Address - Phone:415-948-8130
Mailing Address - Fax:
Practice Address - Street 1:255 10TH AVE
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-2212
Practice Address - Country:US
Practice Address - Phone:415-751-5921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-21
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARADT11101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)