Provider Demographics
NPI:1154170777
Name:SPEARS, KELLY (LSW)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:SPEARS
Suffix:
Gender:
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CROSS POINTE RD STE 800D
Mailing Address - Street 2:
Mailing Address - City:GAHANNA
Mailing Address - State:OH
Mailing Address - Zip Code:43230-6687
Mailing Address - Country:US
Mailing Address - Phone:614-835-6068
Mailing Address - Fax:614-524-0428
Practice Address - Street 1:800 CROSS POINTE RD STE 800D
Practice Address - Street 2:
Practice Address - City:GAHANNA
Practice Address - State:OH
Practice Address - Zip Code:43230-6687
Practice Address - Country:US
Practice Address - Phone:614-835-6068
Practice Address - Fax:614-524-0428
Is Sole Proprietor?:No
Enumeration Date:2024-05-15
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical