Individual
NICOLE SPANGENBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1499 6TH ST, GREEN BAY, WI 54304-2252
(920) 621-7590
Mailing address
1499 6TH ST, GREEN BAY, WI 54304-2252
(920) 621-7590
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
106S00000X
—
WI
Enumeration date
10/28/2019
Last updated
10/28/2019
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