Provider Demographics
NPI:1023709144
Name:SPOTANSKI, MACIE ELIZABETH
Entity type:Individual
Prefix:
First Name:MACIE
Middle Name:ELIZABETH
Last Name:SPOTANSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MACIE
Other - Middle Name:SPOTANSKI
Other - Last Name:SCHABEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11112 JOHN GALT BLVD
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-9838
Mailing Address - Country:US
Mailing Address - Phone:402-347-4191
Mailing Address - Fax:646-859-4440
Practice Address - Street 1:11112 JOHN GALT BLVD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-9838
Practice Address - Country:US
Practice Address - Phone:402-347-4191
Practice Address - Fax:646-859-4440
Is Sole Proprietor?:No
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician