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 1:1013 REGENCY DR
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95926-3216
Mailing Address - Country:US
Mailing Address - Phone:520-242-7554
Mailing Address - Fax:916-604-9107
Practice Address - Street 1:50 LANDING CIR
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95973-7873
Practice Address - Country:US
Practice Address - Phone:520-242-7554
Practice Address - Fax:916-604-9107
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-15
Last Update Date:2024-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS241061041C0700X
AZLCSW-181621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGH7678OtherPTAN