Provider Demographics
NPI:1710291786
Name:KELLY SPEARS, INC.
Entity Type:Organization
Organization Name:KELLY SPEARS, INC.
Other - Org Name:SPEARS LEARNING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/SLP
Authorized Official - Prefix:MS
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:SPEARS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, CCC-SLP/BCBA
Authorized Official - Phone:504-388-6848
Mailing Address - Street 1:2612 METAIRIE RD
Mailing Address - Street 2:
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70001-5426
Mailing Address - Country:US
Mailing Address - Phone:504-309-5679
Mailing Address - Fax:504-309-5694
Practice Address - Street 1:2612 METAIRIE RD
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-5426
Practice Address - Country:US
Practice Address - Phone:504-309-5679
Practice Address - Fax:504-309-5694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2014-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-10-7637251S00000X
261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2350005Medicaid
LA1814105Medicaid