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General NPI Number Information
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NPI Number | 1780547851
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Entity Type | Organization
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Legal Business Name | SPARK PEDIATRIC THERAPY
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Dates
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Enumeration Date | 12/05/2025
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Last Update Date | 12/05/2025
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Provider Practice Location Address
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Address Line | 2620 JENA ST FL 2
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City | NEW ORLEANS
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State | LA
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Zip | 70115-6325
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Country | US
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Telephone | 504-222-2447
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 JENA ST FL 2
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City | NEW ORLEANS
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State | LA
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Zip | 70115-6325
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Country | US
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Telephone | 504-222-2447
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. KRISTEN FERNANDEZ
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Credential | MCD, CCC-SLP
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Telephone | 202-841-2852
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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 |
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License Number State |
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