Provider Demographics
NPI:1558794545
Name:SPADER-CLOUD, MICHELLE (PSYD, BCBA-D)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:SPADER-CLOUD
Suffix:
Gender:F
Credentials:PSYD, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6260 S SUNBURY RD STE 5
Mailing Address - Street 2:
Mailing Address - City:WESTERVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43081-9003
Mailing Address - Country:US
Mailing Address - Phone:614-852-4152
Mailing Address - Fax:614-852-4151
Practice Address - Street 1:6260 S SUNBURY RD
Practice Address - Street 2:SUITE 5
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43081-9002
Practice Address - Country:US
Practice Address - Phone:937-776-9387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-14
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH6516103TC2200X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1972952463Medicaid