Provider Demographics
NPI:1487077046
Name:SPA COMMUNICATION, LLC
Entity type:Organization
Organization Name:SPA COMMUNICATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SPEECH PATHOLOGIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTE
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:BARNES-PERRIN
Authorized Official - Suffix:
Authorized Official - Credentials:SLP-CCC
Authorized Official - Phone:208-631-0585
Mailing Address - Street 1:23 E 1ST ST N
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:ID
Mailing Address - Zip Code:83644-5867
Mailing Address - Country:US
Mailing Address - Phone:208-585-6678
Mailing Address - Fax:
Practice Address - Street 1:23 E 1ST ST N
Practice Address - Street 2:
Practice Address - City:MIDDLETON
Practice Address - State:ID
Practice Address - Zip Code:83644-5867
Practice Address - Country:US
Practice Address - Phone:208-585-6678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-31
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDSLP-1124235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Single Specialty