Provider Demographics
NPI:1518360809
Name:SPECK, KATHLEEN
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SPECK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2500 MCCLELLAN AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PENNSAUKEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08109-4613
Mailing Address - Country:US
Mailing Address - Phone:856-361-1106
Mailing Address - Fax:856-488-1450
Practice Address - Street 1:2500 MCCLELLAN AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:PENNSAUKEN
Practice Address - State:NJ
Practice Address - Zip Code:08109-4613
Practice Address - Country:US
Practice Address - Phone:856-361-1106
Practice Address - Fax:856-488-1450
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst