Individual
JOSH SPENCER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
BA
Contact information
Practice address
500 GROTTO ST N, SAINT PAUL, MN 55104-1754
(651) 760-3236
Mailing address
500 GROTTO ST N, SAINT PAUL, MN 55104-1754
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
1071447
MN
171M00000X
Case Manager/Care Coordinator
Primary
264457487
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M726478300
—
MN
Enumeration date
10/25/2016
Last updated
10/26/2016
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