Provider Demographics
NPI:1184906828
Name:SPATOLA, JENNIFER JO (LAC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JO
Last Name:SPATOLA
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7448 68TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:CANDO
Mailing Address - State:ND
Mailing Address - Zip Code:58324-9485
Mailing Address - Country:US
Mailing Address - Phone:701-968-2568
Mailing Address - Fax:701-968-2560
Practice Address - Street 1:7448 68TH AVE NE
Practice Address - Street 2:
Practice Address - City:CANDO
Practice Address - State:ND
Practice Address - Zip Code:58324-9485
Practice Address - Country:US
Practice Address - Phone:701-968-2568
Practice Address - Fax:701-968-2560
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1524101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)