MEDICARE: SPA, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	1842	AR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043332612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SPA, INC.

Provider Business Mailing Address
First Line	:	3423 E HIGHLAND DR STE A
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-6404
Country	:	US
Telephone Number	:	870-336-0021
Fax Number	:	870-336-0022

Provider Business Practice Location Address
First Line	:	3423 E HIGHLAND DR STE A
Second Line	:
City	:	JONESBORO
State	:	AR
Zip	:	72401-6404
Country	:	US
Telephone Number	:	870-336-0021
Fax Number	:	870-336-0022

Authorized Official
Title or Position	:	SPEECH LANGUAGE PATHOLOGIST
Name	:	LORI R MALONE
Credential	:	MCDCCC-SLP
Telephone Number	:	870-336-0021

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	06/20/2008

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Directions to “SPA, INC. ” Practice Location

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