Individual
SPENCER E SHOTLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LADC, CADC III
Contact information
Practice address
115 6TH STREET NW, CASS LAKE, MN 56633
(218) 760-9257
Mailing address
115 6TH STREET NW, CASS LAKE, MN 56633
(218) 760-9257
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
302091
MN
Other
Enumeration date
08/22/2011
Last updated
08/22/2011
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