Provider Demographics
NPI:1821436973
Name:SPADE, RAYMOND K (SAC)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:K
Last Name:SPADE
Suffix:
Gender:M
Credentials:SAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2240 PRAIRIE AVE
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:WI
Mailing Address - Zip Code:53511-2648
Mailing Address - Country:US
Mailing Address - Phone:608-361-7200
Mailing Address - Fax:608-361-7201
Practice Address - Street 1:2240 PRAIRIE AVE.
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:WI
Practice Address - Zip Code:53511
Practice Address - Country:US
Practice Address - Phone:608-361-7200
Practice Address - Fax:608-361-7201
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI16737130101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)