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General NPI Number Information
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NPI Number | 1619956620
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Entity Type | Individual
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Provider Name | SREELATHA S SPIEKER MD
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Gender | Female
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Dates
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Enumeration Date | 01/10/2006
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Last Update Date | 07/15/2020
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Provider Practice Location Address
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Address Line | 1400 MADISON AVE.MADISON EAST CENTER SUITE 352 MANKATO CLINIC DEPARTMENT OF PSYCHIATRY
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City | MANKATO
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State | MN
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Zip | 56001
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Country | US
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Telephone | 507-387-3195
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8674 1230 E MAIN ST MANKATO CLINIC LTD
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City | MANKATO
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State | MN
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Zip | 56002-8674
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Country | US
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Telephone | 507-625-1811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 47784
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 2084P0804X
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Taxonomy Name | Child & Adolescent Psychiatry Physician
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License Number | 47784
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License Number State | MN
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