Provider Demographics
NPI:1477251437
Name:SPEASE, JADA A
Entity Type:Individual
Prefix:
First Name:JADA
Middle Name:A
Last Name:SPEASE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 NW 7TH AVE # 14310
Mailing Address - Street 2:SMB#42642
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33311-8135
Mailing Address - Country:US
Mailing Address - Phone:954-868-0255
Mailing Address - Fax:
Practice Address - Street 1:954 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2951
Practice Address - Country:US
Practice Address - Phone:813-384-8505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-20
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW178841041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLISW17884OtherREGISTERED CLINICAL SOCIAL WORKER INTERN