Provider Demographics
NPI:1225367725
Name:SPECK-KERN, ELIZABETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:SPECK-KERN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:E
Other - Last Name:SPECK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3 INNWOOD CR., STE 111
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211
Mailing Address - Country:US
Mailing Address - Phone:501-664-1050
Mailing Address - Fax:888-684-7266
Practice Address - Street 1:3 INNWOOD CR., STE 111
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211
Practice Address - Country:US
Practice Address - Phone:501-664-1050
Practice Address - Fax:888-684-7266
Is Sole Proprietor?:No
Enumeration Date:2009-12-11
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR8621P103T00000X
AR103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist