Healthcare Provider Details

I. General information

NPI: 1558794545
Provider Name (Legal Business Name): MICHELLE SPADER-CLOUD PSYD, BCBA-D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2013
Last Update Date: 02/23/2022
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6260 S SUNBURY RD SUITE 5
WESTERVILLE OH
43081-9002
US

IV. Provider business mailing address

6260 S SUNBURY RD STE 5
WESTERVILLE OH
43081-9003
US

V. Phone/Fax

Practice location:
  • Phone: 937-776-9387
  • Fax:
Mailing address:
  • Phone: 614-852-4152
  • Fax: 614-852-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number6516
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number6516
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: