| Speare & Sampson Pa | |
|
225 1st St N Suite 3100 Virginia MN 55792 | |
| (218) 741-3740 | |
| Not Available |
| Full Name | Speare & Sampson Pa |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 225 1st St N, Virginia, Minnesota |
| Authorized Official Name and Position | Jonathan Speare (CEO) |
| Authorized Official Contact | 2187413740 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Speare & Sampson Pa 225 1st St N Suite 3100 Virginia MN 55792 Ph: (218) 741-3740 | Speare & Sampson Pa 225 1st St N Suite 3100 Virginia MN 55792 Ph: (218) 741-3740 |
| NPI Number | 1366659005 |
|---|---|
| Provider Enumeration Date | 05/16/2007 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366659005 | NPI | - | NPPES |
| 110499 | Other | MN | UCARE |
| 8L596SP | Other | MN | BCBS |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | LP1373 (Minnesota) | Primary |
| 103TC0700X | Psychologist - Clinical | LP0655 (Minnesota) | Secondary |
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