Provider Demographics
NPI:1932506995
Name:SPOON, MARILYN JEAN X (CADC)
Entity Type:Individual
Prefix:MS
First Name:MARILYN
Middle Name:JEAN
Last Name:SPOON
Suffix:X
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 305TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMA
Mailing Address - State:IA
Mailing Address - Zip Code:52339-9698
Mailing Address - Country:US
Mailing Address - Phone:641-484-9420
Mailing Address - Fax:641-484-9477
Practice Address - Street 1:1646 305TH ST
Practice Address - Street 2:
Practice Address - City:TAMA
Practice Address - State:IA
Practice Address - Zip Code:52339-9698
Practice Address - Country:US
Practice Address - Phone:641-484-9420
Practice Address - Fax:641-484-9477
Is Sole Proprietor?:No
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator