Provider Demographics
NPI:1366880700
Name:JOHN, SHANNONELAINE SPALDING (MA)
Entity type:Individual
Prefix:
First Name:SHANNONELAINE
Middle Name:SPALDING
Last Name:JOHN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1132
Mailing Address - Street 2:
Mailing Address - City:FORT MORGAN
Mailing Address - State:CO
Mailing Address - Zip Code:80701-1132
Mailing Address - Country:US
Mailing Address - Phone:720-215-5042
Mailing Address - Fax:
Practice Address - Street 1:423 MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-2154
Practice Address - Country:US
Practice Address - Phone:720-443-0406
Practice Address - Fax:970-867-2695
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)