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NPI Code Detail

MEDICARE: SHELBIE SPEAR DTLLP

MEDICARE: SHELBIE SPEAR DTLLP
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
1103T00000XPsychologistMI

General Provider Information

NPI Number : 1982198784
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHELBIE SPEAR DTLLP
Provider Business Mailing Address
First Line : 737 CRESCENT ST NE
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49503-3501
Country : US
Telephone Number : 231-571-0205
Fax Number :
Provider Business Practice Location Address
First Line : 4690 FULTON ST E STE 102
Second Line :
City : ADA
State : MI
Zip : 49301-8454
Country : US
Telephone Number : 616-425-7701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/15/2018
Last Update Date : 04/23/2024

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Directions to “ SHELBIE SPEAR DTLLP” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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