Healthcare Provider Details

I. General information

NPI: 1710291786
Provider Name (Legal Business Name): KELLY SPEARS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2010
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2612 METAIRIE RD
METAIRIE LA
70001-5426
US

IV. Provider business mailing address

2612 METAIRIE RD
METAIRIE LA
70001-5426
US

V. Phone/Fax

Practice location:
  • Phone: 504-309-5679
  • Fax: 504-309-5694
Mailing address:
  • Phone: 504-309-5679
  • Fax: 504-309-5694

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number1-10-7637
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code261QH0700X
TaxonomyHearing and Speech Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. KRISTEN KELLY SPEARS
Title or Position: PRESIDENT/SLP
Credential: MS, CCC-SLP/BCBA
Phone: 504-388-6848