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General NPI Number Information
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NPI Number | 1043332612
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Entity Type | Organization
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Legal Business Name | SPA, INC.
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Dates
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Enumeration Date | 04/04/2007
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Last Update Date | 06/20/2008
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Provider Practice Location Address
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Address Line | 3423 E HIGHLAND DR STE A
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City | JONESBORO
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State | AR
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Zip | 72401-6404
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Country | US
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Telephone | 870-336-0021
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Fax | 870-336-0022
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Provider Business Mailing Address
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Address Line | 3423 E HIGHLAND DR STE A
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City | JONESBORO
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State | AR
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Zip | 72401-6404
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Country | US
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Telephone | 870-336-0021
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Fax | 870-336-0022
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Authorized Official
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Title or Position | SPEECH LANGUAGE PATHOLOGIST
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Name | LORI R MALONE
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Credential | MCDCCC-SLP
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Telephone | 870-336-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 1842
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License Number State | AR
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