Provider Demographics
NPI:1255658936
Name:SPEEGLE, MARTHA GAYLE (LMSW)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:GAYLE
Last Name:SPEEGLE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:NH 27 LAKE CHEROKEE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75603-9519
Mailing Address - Country:US
Mailing Address - Phone:903-315-7630
Mailing Address - Fax:
Practice Address - Street 1:NH 27 LAKE CHEROKEE
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75603-9519
Practice Address - Country:US
Practice Address - Phone:903-315-7630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-21
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX53907104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker