Individual
MR. RANDALL P. SPANGLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CSAC, ICS
Contact information
Practice address
502 MAIN ST W STE 305, ASHLAND, WI 54806-1512
(715) 682-5207
(715) 682-5209
Mailing address
621 18TH AVE W, ASHLAND, WI 54806
(715) 682-8015
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
7044-135
WI
101YA0400X
Addiction (Substance Use Disorder) Counselor
72-132
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
39317500
—
WI
Enumeration date
03/30/2007
Last updated
07/09/2007
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