Provider Demographics
NPI:1700918331
Name:SPIETH, STEPHEN FREDERICK (MA)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:FREDERICK
Last Name:SPIETH
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 S 53RD CT
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-2426
Mailing Address - Country:US
Mailing Address - Phone:708-423-3361
Mailing Address - Fax:708-499-7093
Practice Address - Street 1:9401 S 53RD CT
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2426
Practice Address - Country:US
Practice Address - Phone:708-423-3361
Practice Address - Fax:708-499-7093
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health