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KEVIN SPADING

Addiction Substance Use Disorder

Lake Elmo, Minnesota

Provider NPI: 1972592954

Provider Information:
 KEVIN  SPADING 
Gender: M


Practice Location:
8669 EAGLE POINT BLVD  LAKE ELMO, MN 55042 US
Tel: 651-379-0444  Fax: 651-379-0434

Business Mailing Address:
8669 EAGLE POINT BLVD  LAKE ELMO, MN 55042 US
Tel: 651-379-0444  Fax: 651-379-0434

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X101YA0400XBehavioral Health & Social Service Providers
Counselor
Addiction (Substance Use Disorder)
MN300537
X1041C0700XBehavioral Health & Social Service Providers
Social Worker
MN12613

Other Provider Identifiers:

IssuerNumberStateType
MEDICA/UBH ID#62-57490MN01
HEALTH PARTNERSHP42060MN01
BCBS ID#539T6SPMN01
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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