Provider Demographics
NPI:1639419286
Name:SPENCE ALGUIRE, ANA ISABEL (MED, LPCC)
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:ISABEL
Last Name:SPENCE ALGUIRE
Suffix:
Gender:F
Credentials:MED, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11550 STILLWATER BLVD N STE 105B
Mailing Address - Street 2:
Mailing Address - City:LAKE ELMO
Mailing Address - State:MN
Mailing Address - Zip Code:55042-8613
Mailing Address - Country:US
Mailing Address - Phone:320-342-0897
Mailing Address - Fax:
Practice Address - Street 1:11550 STILLWATER BLVD N STE 105B
Practice Address - Street 2:
Practice Address - City:LAKE ELMO
Practice Address - State:MN
Practice Address - Zip Code:55042-8613
Practice Address - Country:US
Practice Address - Phone:320-342-0897
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-19
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCC00445101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCC00445Medicaid