Provider Demographics
NPI:1720172802
Name:SPIEGELHOFF, LUKE PHILLIP (LICSW)
Entity Type:Individual
Prefix:MR
First Name:LUKE
Middle Name:PHILLIP
Last Name:SPIEGELHOFF
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1385 MENDOTA HEIGHTS RD. STE 200
Mailing Address - Street 2:
Mailing Address - City:MENDOTA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55120
Mailing Address - Country:US
Mailing Address - Phone:651-379-9800
Mailing Address - Fax:651-405-0358
Practice Address - Street 1:1385 MENDOTA HEIGHTS RD. STE 200
Practice Address - Street 2:
Practice Address - City:MENDOTA HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55120
Practice Address - Country:US
Practice Address - Phone:651-379-9800
Practice Address - Fax:651-405-0358
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN98021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN332524500Medicaid