Individual
TARESA JANELLE SPADE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
12508 HAWK LN, CLINTON, MT 59825-9033
(808) 359-4730
Mailing address
1522 E SHORE DR, DETROIT LAKES, MN 56501-4707
(808) 359-4730
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
101117
CA
1041C0700X
Clinical Social Worker
149.026956
IL
1041C0700X
Clinical Social Worker
15379
OR
1041C0700X
Clinical Social Worker
31664
MN
1041C0700X
Clinical Social Worker
61317222
WA
1041C0700X
Clinical Social Worker
Primary
BBH-LCSW-LIC-42656
MT
1041C0700X
Clinical Social Worker
LCSW-4493
HI
Other
Enumeration date
04/14/2020
Last updated
04/02/2026
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