Individual
MR. JACOB P SPANGENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC
Contact information
Practice address
2979 ALLIED ST, UNIT C, GREEN BAY, WI 54304-5567
(920) 337-6740
(920) 337-6741
Mailing address
2979 ALLIED ST, UNIT C, GREEN BAY, WI 54304-5567
(920) 337-6740
(920) 337-6741
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
15832-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10063000
—
WI
Enumeration date
10/25/2010
Last updated
12/02/2014
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