Provider Demographics
NPI:1730636317
Name:SPADER, AUDREY (SLP)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:SPADER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N. SECTION LINE ST.
Mailing Address - Street 2:HOWARD SCHOOL DISTRICT,
Mailing Address - City:HOWARD
Mailing Address - State:SD
Mailing Address - Zip Code:57349
Mailing Address - Country:US
Mailing Address - Phone:605-772-5515
Mailing Address - Fax:605-772-5516
Practice Address - Street 1:201 N MINNIE ST
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:SD
Practice Address - Zip Code:57349-8725
Practice Address - Country:US
Practice Address - Phone:605-772-4443
Practice Address - Fax:605-772-4445
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD454-SLP235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist