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General NPI Number Information
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NPI Number | 1477251437
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Entity Type | Individual
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Provider Name | JADA A SPEASE
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Gender | Female
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Dates
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Enumeration Date | 02/20/2023
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Last Update Date | 03/01/2023
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Provider Practice Location Address
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Address Line | 954 MAGNOLIA AVE
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City | PANAMA CITY
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State | FL
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Zip | 32401-2951
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Country | US
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Telephone | 813-384-8505
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Fax |
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Provider Business Mailing Address
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Address Line | 400 NW 7TH AVE # 14310 SMB#42642
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City | FT LAUDERDALE
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State | FL
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Zip | 33311-8135
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Country | US
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Telephone | 954-868-0255
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | ISW17884
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License Number State | FL
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