Provider Demographics
NPI:1295260495
Name:SPICER, KORA J (SLP)
Entity type:Individual
Prefix:
First Name:KORA
Middle Name:J
Last Name:SPICER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:KORA
Other - Middle Name:J
Other - Last Name:CHRISTIAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SLP
Mailing Address - Street 1:3060 FRONTIER WAY S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58104-8909
Mailing Address - Country:US
Mailing Address - Phone:701-232-2340
Mailing Address - Fax:701-232-2330
Practice Address - Street 1:2600 DEMERS AVE STE 101
Practice Address - Street 2:
Practice Address - City:GRAND FORKS
Practice Address - State:ND
Practice Address - Zip Code:58201-4100
Practice Address - Country:US
Practice Address - Phone:701-757-3045
Practice Address - Fax:701-787-4354
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND1557235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1474396Medicaid