Provider Demographics
NPI:1063575702
Name:SPEDOWFSKI, KAREN LEE (PHD)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:LEE
Last Name:SPEDOWFSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 VACA VALLEY PKWY
Mailing Address - Street 2:KAISER PERMANENTE, CDS, SECOND FLOOR
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9430
Mailing Address - Country:US
Mailing Address - Phone:707-453-5470
Mailing Address - Fax:707-453-2993
Practice Address - Street 1:3700 VACA VALLEY PKWY
Practice Address - Street 2:KAISER PERMANENTE, CDS, SECOND FLOOR
Practice Address - City:VACAVILLE
Practice Address - State:CA
Practice Address - Zip Code:95688-9430
Practice Address - Country:US
Practice Address - Phone:707-453-5470
Practice Address - Fax:707-453-2993
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17518302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization