Provider Demographics
NPI:1164917753
Name:SPECK, PHILLIP M (QMHS)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:M
Last Name:SPECK
Suffix:
Gender:M
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 RUTH AVE
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2940
Mailing Address - Country:US
Mailing Address - Phone:330-883-4894
Mailing Address - Fax:
Practice Address - Street 1:9500 DETROIT AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-1852
Practice Address - Country:US
Practice Address - Phone:216-283-4400
Practice Address - Fax:216-283-5359
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2018-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator