Provider Demographics
NPI:1063454700
Name:SPEIDEN, JEFFREY SCOTT (PH D HSPP)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:SCOTT
Last Name:SPEIDEN
Suffix:
Gender:M
Credentials:PH D HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4845 GOLDENRAIN COURT
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46237-2564
Mailing Address - Country:US
Mailing Address - Phone:317-440-7992
Mailing Address - Fax:317-791-1939
Practice Address - Street 1:4845 GOLDENRAIN COURT
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-2564
Practice Address - Country:US
Practice Address - Phone:317-440-7992
Practice Address - Fax:317-791-1939
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20040943A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical