Provider Demographics
NPI:1952656092
Name:SPEHLING, SUSAN LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:LYNN
Last Name:SPEHLING
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 JASPER DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-6808
Mailing Address - Country:US
Mailing Address - Phone:530-360-0124
Mailing Address - Fax:916-604-9107
Practice Address - Street 1:1000 G ST STE 125
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95814-0894
Practice Address - Country:US
Practice Address - Phone:530-360-0124
Practice Address - Fax:916-604-9107
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-181621041C0700X
CALCS241061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGH7678OtherPTAN