Provider Demographics
NPI:1093511032
Name:SPANN, ALICIA ANN MARIE
Entity type:Individual
Prefix:
First Name:ALICIA ANN
Middle Name:MARIE
Last Name:SPANN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 COLUMBINE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2236
Mailing Address - Country:US
Mailing Address - Phone:505-916-7618
Mailing Address - Fax:
Practice Address - Street 1:12121 NM HIGHWAY 14
Practice Address - Street 2:
Practice Address - City:CEDAR CREST
Practice Address - State:NM
Practice Address - Zip Code:87008-8711
Practice Address - Country:US
Practice Address - Phone:505-916-7618
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-20
Last Update Date:2025-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician