Healthcare Provider Details

I. General information

NPI: 1013623396
Provider Name (Legal Business Name): JOHN BILL SPAEDT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2023
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1831 CAMINO DEL LLANO
BELEN NM
87002-2619
US

IV. Provider business mailing address

2805 CHARLES BRYAN RD
BARTLETT TN
38134-4756
US

V. Phone/Fax

Practice location:
  • Phone: 505-864-1600
  • Fax:
Mailing address:
  • Phone: 901-701-5995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSAH-2025-0039
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number5703
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: