Provider Demographics
NPI:1376516047
Name:SPEED, LILIANA F (EDD)
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:F
Last Name:SPEED
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:SPEED
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EDD
Mailing Address - Street 1:2607 NW 65TH ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-4905
Mailing Address - Country:US
Mailing Address - Phone:405-842-3550
Mailing Address - Fax:
Practice Address - Street 1:2607 NW 65TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-4905
Practice Address - Country:US
Practice Address - Phone:405-842-3550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-10
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK424103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100836880CMedicaid
OK100836880CMedicaid