Provider Demographics
NPI:1932614757
Name:STEPHEN D SPEIDEL N.D., PC
Entity Type:Organization
Organization Name:STEPHEN D SPEIDEL N.D., PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:CASANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-697-2122
Mailing Address - Street 1:19586 10TH AVE NE STE 100
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-7332
Mailing Address - Country:US
Mailing Address - Phone:360-697-2122
Mailing Address - Fax:360-697-4617
Practice Address - Street 1:19586 10TH AVE NE STE 100
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-7332
Practice Address - Country:US
Practice Address - Phone:360-697-2122
Practice Address - Fax:360-697-4617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2019-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT00000447175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty