Provider Demographics
NPI:1376843011
Name:SPEICHER, AMANDA W (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:W
Last Name:SPEICHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2170
Mailing Address - Street 2:
Mailing Address - City:NEW LONDON
Mailing Address - State:CT
Mailing Address - Zip Code:06320-2170
Mailing Address - Country:US
Mailing Address - Phone:860-443-0036
Mailing Address - Fax:860-443-4284
Practice Address - Street 1:165 STATE ST
Practice Address - Street 2:SUITE 200
Practice Address - City:NEW LONDON
Practice Address - State:CT
Practice Address - Zip Code:06320-6397
Practice Address - Country:US
Practice Address - Phone:860-443-0036
Practice Address - Fax:860-443-4284
Is Sole Proprietor?:No
Enumeration Date:2010-10-28
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT398212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry