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NPI Code Detail

MEDICARE: KELLY SPEARS, INC.

MEDICARE: KELLY SPEARS, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency1-10-7637LA
2261QH0700XHearing and Speech Clinic/Center

Other Identifiers

General Provider Information

NPI Number : 1710291786
Entity Type Code : Organization
Provider Name (Legal Business Name) : KELLY SPEARS, INC.
Provider Business Mailing Address
First Line : 2612 METAIRIE RD
Second Line :
City : METAIRIE
State : LA
Zip : 70001-5426
Country : US
Telephone Number : 504-309-5679
Fax Number : 504-309-5694
Provider Business Practice Location Address
First Line : 2612 METAIRIE RD
Second Line :
City : METAIRIE
State : LA
Zip : 70001-5426
Country : US
Telephone Number : 504-309-5679
Fax Number : 504-309-5694
Authorized Official
Title or Position : PRESIDENT/SLP
Name : MS. KRISTEN KELLY SPEARS
Credential : MS, CCC-SLP/BCBA
Telephone Number : 504-388-6848
Provider Enumeration Date : 08/02/2010
Last Update Date : 03/12/2014

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