Healthcare Provider Details

I. General information

NPI: 1194877811
Provider Name (Legal Business Name): KAREN RINARDO SPEIER PHD, MP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 STEELE BOULEVARD
BATON ROUGE LA
70806-5742
US

IV. Provider business mailing address

650 STEELE BOULEVARD
BATON ROUGE LA
70806-5742
US

V. Phone/Fax

Practice location:
  • Phone: 225-383-2100
  • Fax: 225-383-2108
Mailing address:
  • Phone: 225-383-2100
  • Fax: 225-383-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number504
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number504
License Number StateLA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number504
License Number StateLA
# 4
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberMP.0504
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: