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Individual

KRISTIE LYNN SPOONER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LAC, LSW

Contact information

Practice address
3201 FIECHTNER DR S, FARGO, ND 58103-2358
(701) 293-3384
(651) 925-0057
Mailing address
PO BOX 2055, JAMESTOWN, ND 58402-2055
(701) 253-6366
(701) 253-6400

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1358
ND
104100000X
Social Worker
2163
ND

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
011580
BCBS PROVIDER NUMBER
ND
Enumeration date
08/21/2006
Last updated
11/16/2017
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