Organization
SPEARE & SAMPSON PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JONATHAN SPEARE PHD LIC PSYCHOLOGIST (CEO)
(218) 741-3740
Entity
Organization
Contact information
Practice address
225 1ST ST N, SUITE 3100, VIRGINIA, MN 55792
(218) 741-3740
Mailing address
225 1ST ST N, SUITE 3100, VIRGINIA, MN 55792
(218) 741-3740
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
LP0655
MN
103TC0700X
Clinical Psychologist
Primary
LP1373
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110499
UCARE
MN
01
—
8L596SP
BCBS
MN
Enumeration date
05/16/2007
Last updated
08/22/2020
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