Provider Demographics
NPI:1619956620
Name:SPIEKER, SREELATHA S (MD)
Entity Type:Individual
Prefix:
First Name:SREELATHA
Middle Name:S
Last Name:SPIEKER
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 8674
Mailing Address - Street 2:1230 E MAIN ST MANKATO CLINIC LTD
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1400 MADISON AVE.MADISON EAST CENTER
Practice Address - Street 2:SUITE 352 MANKATO CLINIC DEPARTMENT OF PSYCHIATRY
Practice Address - City:MANKATO
Practice Address - State:MN
Practice Address - Zip Code:56001
Practice Address - Country:US
Practice Address - Phone:507-387-3195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2020-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN477842084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN004132700Medicaid
MN2365802OtherAMERICAS PPO
IA0596627OtherMEDICAID
MN136439OtherUCARE
214P3SPOtherBCBSM
NA2951044076OtherPREFFERED ONE
MNHP53201OtherHEALTH PARTNERS
214P3SPOtherBCBSM
I13038Medicare UPIN