Healthcare Provider Details

I. General information

NPI: 1295038537
Provider Name (Legal Business Name): COLLEEN SPIEKER MS, CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2010
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 E BALTIMORE PIKE STE 203
MEDIA PA
19063-5126
US

IV. Provider business mailing address

5 E RIDGE RD
MEDIA PA
19063-2540
US

V. Phone/Fax

Practice location:
  • Phone: 570-242-2830
  • Fax:
Mailing address:
  • Phone: 570-242-2830
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberO1-0001443
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSL012293
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: