Provider Demographics
NPI:1669215497
Name:SPEICKER, DELANEY MARIE
Entity type:Individual
Prefix:
First Name:DELANEY
Middle Name:MARIE
Last Name:SPEICKER
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 1:2627 S BROCKSMITH RD
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34945-4410
Mailing Address - Country:US
Mailing Address - Phone:772-342-6468
Mailing Address - Fax:
Practice Address - Street 1:8270 WOODLAND CENTER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2401
Practice Address - Country:US
Practice Address - Phone:813-417-7879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLBACB1090215103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst