Provider Demographics
NPI:1780634741
Name:SPAR, AMY LYNN (MA, CCC-SLP, RD,LD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:LYNN
Last Name:SPAR
Suffix:
Gender:F
Credentials:MA, CCC-SLP, RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4116 TOWNSHIP ROAD 55
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-9436
Mailing Address - Country:US
Mailing Address - Phone:419-634-5049
Mailing Address - Fax:
Practice Address - Street 1:1973 STATE ROUTE 47 W
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9328
Practice Address - Country:US
Practice Address - Phone:937-292-3056
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-11
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHL1108133V00000X
OHSP.10666235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSPMT71251Medicare UPIN