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General NPI Number Information
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NPI Number | 1730530460
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Entity Type | Organization
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Legal Business Name | DR. SPEED, INC.
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Dates
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Enumeration Date | 06/23/2016
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Last Update Date | 01/09/2017
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Provider Practice Location Address
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Address Line | 672 W 11TH ST STE 100
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City | TRACY
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State | CA
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Zip | 95376-3821
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Country | US
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Telephone | 209-834-4302
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Fax |
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Provider Business Mailing Address
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Address Line | 672 W 11TH ST STE 100
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City | TRACY
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State | CA
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Zip | 95376-3821
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Country | US
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Telephone | 209-834-4302
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/PRESIDENT
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Name | DR. CHRISTIANE D SPEED
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Credential | PSY.D.
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Telephone | 209-834-4302
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY24865
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License Number State | CA
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