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NPI Code Detail

MEDICARE: KRISTEN KELLY SPEARS MS, CCC-SLP, BCBA

MEDICARE: KRISTEN KELLY SPEARS MS, CCC-SLP, BCBA
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
1235Z00000XSpeech-Language Pathologist5820LA
2103K00000XBehavior Analyst1-10-7637LA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093044208
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN KELLY SPEARS MS, CCC-SLP, BCBA
Provider Business Mailing Address
First Line : 2612 METAIRIE RD
Second Line :
City : METAIRIE
State : LA
Zip : 70001-5426
Country : US
Telephone Number : 504-388-6848
Fax Number :
Provider Business Practice Location Address
First Line : 2612 METAIRIE RD
Second Line :
City : METAIRIE
State : LA
Zip : 70001-5426
Country : US
Telephone Number : 504-388-6848
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/17/2009
Last Update Date : 02/10/2014

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Directions to “ KRISTEN KELLY SPEARS MS, CCC-SLP, BCBA” Practice Location

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