Healthcare Provider Details

I. General information

NPI: 1619956620
Provider Name (Legal Business Name): SREELATHA S SPIEKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2006
Last Update Date: 07/15/2020
Certification Date: 07/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 MADISON AVE.MADISON EAST CENTER SUITE 352 MANKATO CLINIC DEPARTMENT OF PSYCHIATRY
MANKATO MN
56001
US

IV. Provider business mailing address

PO BOX 8674 1230 E MAIN ST MANKATO CLINIC LTD
MANKATO MN
56002-8674
US

V. Phone/Fax

Practice location:
  • Phone: 507-387-3195
  • Fax:
Mailing address:
  • Phone: 507-625-1811
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number47784
License Number StateMN
# 2
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number47784
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: