Provider Demographics
NPI:1205138542
Name:SPIES, RAENELL
Entity type:Individual
Prefix:
First Name:RAENELL
Middle Name:
Last Name:SPIES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4005 S WESTERN RD
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-2402
Mailing Address - Country:US
Mailing Address - Phone:503-781-8688
Mailing Address - Fax:
Practice Address - Street 1:2525 NW EXPRESSWAY STE 624A
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7596
Practice Address - Country:US
Practice Address - Phone:405-242-5070
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst