Provider Demographics
NPI:1003090648
Name:SPEES, DELICIA MARILYN I
Entity Type:Individual
Prefix:MRS
First Name:DELICIA
Middle Name:MARILYN
Last Name:SPEES
Suffix:I
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 SPRUCE AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:SOUTH LAKE TAHOE
Mailing Address - State:CA
Mailing Address - Zip Code:96150-8317
Mailing Address - Country:US
Mailing Address - Phone:530-542-0740
Mailing Address - Fax:530-542-0397
Practice Address - Street 1:3501 SPRUCE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:SOUTH LAKE TAHOE
Practice Address - State:CA
Practice Address - Zip Code:96150-8317
Practice Address - Country:US
Practice Address - Phone:530-542-0740
Practice Address - Fax:530-542-0397
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator