Provider Demographics
NPI:1225603095
Name:SPECHT, MICHAELEEN KATE
Entity Type:Individual
Prefix:MRS
First Name:MICHAELEEN
Middle Name:KATE
Last Name:SPECHT
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:MICHAELEEN
Other - Middle Name:KATE
Other - Last Name:SPECHT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNA
Mailing Address - Street 1:151 E BIRCH HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PUEBLO WEST
Mailing Address - State:CO
Mailing Address - Zip Code:81007-7507
Mailing Address - Country:US
Mailing Address - Phone:719-644-2780
Mailing Address - Fax:
Practice Address - Street 1:151 E BIRCH HILLS DR
Practice Address - Street 2:
Practice Address - City:PUEBLO WEST
Practice Address - State:CO
Practice Address - Zip Code:81007-7507
Practice Address - Country:US
Practice Address - Phone:719-644-2780
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-25
Last Update Date:2021-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program