Provider Demographics
NPI:1902215841
Name:SPAENI, MOLLY
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:
Last Name:SPAENI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:740 REGENT ST STE 105
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53715-2648
Mailing Address - Country:US
Mailing Address - Phone:608-305-4221
Mailing Address - Fax:877-563-5731
Practice Address - Street 1:740 REGENT ST STE 105
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53715-2648
Practice Address - Country:US
Practice Address - Phone:608-305-4221
Practice Address - Fax:877-563-5731
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI388-228101YM0800X
WI1236-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health