Speare Psychological Services PA

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP0655 Issued in MN

Legal business name

SPEARE PSYCHOLOGICAL SERVICES PA

Practice address

225 1St St N
Suite 3100
Virginia, MN 55723

Phone

(218) 741-3740

Fax

(218) 741-9492

NPI assigned

Apr 30, 2007

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Jonathan Speare, PHD LICENSED PSYCHOL

Title

Ceo Owner

Phone

(218) 741-3740

Specialties & licenses 1

Addresses

Other identifiers 7

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1177891200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281398400000",
    "number": "1508086679",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "225 1ST ST N",
            "address_2": "SUITE 3100",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "55723",
            "telephone_number": "218-741-3740",
            "fax_number": "218-741-9492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "225 1ST ST N",
            "address_2": "SUITE 3100",
            "city": "VIRGINIA",
            "state": "MN",
            "postal_code": "55723",
            "telephone_number": "218-741-3740",
            "fax_number": "218-741-9492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPEARE PSYCHOLOGICAL SERVICES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-30",
        "last_updated": "2010-08-10",
        "status": "A",
        "authorized_official_last_name": "SPEARE",
        "authorized_official_first_name": "JONATHAN",
        "authorized_official_title_or_position": "CEO OWNER",
        "authorized_official_telephone_number": "218-741-3740",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD LICENSED PSYCHOL"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "MN",
            "license": "LP0655",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VALUE OPTIONS",
            "identifier": "074048",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PREFERREDONE",
            "identifier": "100318",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "850347800",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "000512001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "110500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "6101470",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8L596SP",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Speare & Sampson PA
• Jonathan Speare, PHD LICENSED PSYCHOL
• Spectrum Community Health Inc
• Naomi Sperry
• Paige Lorraine Sperry
• Danielle Rae Spolarich, LPC, LADC

• Clinical Psychologist in Virginia, MN
• Providers in Virginia, MN by specialty
• Clinical Psychologist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.