Provider Demographics
NPI:1285522219
Name:SPOLYAR, LEE ANN
Entity type:Individual
Prefix:
First Name:LEE
Middle Name:ANN
Last Name:SPOLYAR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LEE
Other - Middle Name:ANN
Other - Last Name:DAVID
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:20 DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:COLDWATER
Mailing Address - State:MI
Mailing Address - Zip Code:49036-1966
Mailing Address - Country:US
Mailing Address - Phone:269-489-8311
Mailing Address - Fax:269-489-8311
Practice Address - Street 1:20 DIVISION ST
Practice Address - Street 2:
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-1966
Practice Address - Country:US
Practice Address - Phone:269-489-8311
Practice Address - Fax:269-489-8311
Is Sole Proprietor?:Yes
Enumeration Date:2025-06-26
Last Update Date:2025-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6851119437104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker