Healthcare Provider Details
I. General information
NPI: 1609707090
Provider Name (Legal Business Name): KIDSPOT SPECTRUM INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:
III. Provider practice location address
1801 GRANT AVE
JONESBORO AR
72401-6155
US
IV. Provider business mailing address
1801 GRANT AVE
JONESBORO AR
72401-6155
US
V. Phone/Fax
- Phone: 870-974-9114
- Fax: 870-974-9184
- Phone: 870-974-9114
- Fax: 870-974-9184
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 103K00000X |
| Taxonomy | Behavior Analyst |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
AMY
ROTTINGHAUS
Title or Position: BILLING
Credential:
Phone: 870-974-9114