Jonathan Speare, PHD LICENSED PSYCHOL

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

LP0655 Issued in MN

Practice address

225 1St St N
Suite 3100
Virginia, MN 55792-2457

Phone

(218) 741-3740

NPI assigned

Feb 23, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 7

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Speare & Sampson PA

  • Clinical Psychologist
  • Virginia, MN
  • NPI 1366659005
  NPD Authorized official

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

{
    "created_epoch": "1172188800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1281398400000",
    "number": "1962537282",
    "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": "557922457",
            "telephone_number": "218-741-3740"
        },
        {
            "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": "557922457",
            "telephone_number": "218-741-3740"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SPEARE",
        "first_name": "JONATHAN",
        "name_prefix": "Dr.",
        "credential": "PHD LICENSED PSYCHOL",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-02-23",
        "last_updated": "2010-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_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": "PREFERRED ONE",
            "identifier": "100318",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCARE",
            "identifier": "110500",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "8L597SP",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MAGELLAN",
            "identifier": "000512001",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED BEHAVIORAL HEALTH",
            "identifier": "6101470",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "850347800",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wendell Robert Smith
• Rebecca Marie Soler, DPT
• Sonlight Therapeutic Services
• Speare & Sampson PA
• Speare Psychological Services PA
• Spectrum Community Health Inc
• Naomi Sperry
• Paige Lorraine Sperry
• Danielle Rae Spolarich, LPC, LADC
• Daniel Spooner

• 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.