Provider Demographics
NPI:1386043693
Name:SPEILMAN, RICHELLE (LAC)
Entity Type:Individual
Prefix:
First Name:RICHELLE
Middle Name:
Last Name:SPEILMAN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 E BIRCH AVE
Mailing Address - Street 2:SUITE 4
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-4625
Mailing Address - Country:US
Mailing Address - Phone:928-225-2425
Mailing Address - Fax:
Practice Address - Street 1:107 E BIRCH AVE
Practice Address - Street 2:SUITE 4
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-4625
Practice Address - Country:US
Practice Address - Phone:928-225-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0941171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist