Provider Demographics
NPI:1689860587
Name:SPEICHER, GLORIA DIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:DIANE
Last Name:SPEICHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-5265
Mailing Address - Country:US
Mailing Address - Phone:707-528-3778
Mailing Address - Fax:707-523-2855
Practice Address - Street 1:509 7TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-5265
Practice Address - Country:US
Practice Address - Phone:707-528-3778
Practice Address - Fax:707-523-2855
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-25
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9935103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical