Healthcare Provider Details

I. General information

NPI: 1518360809
Provider Name (Legal Business Name): KATHLEEN SPECK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 MCCLELLAN AVE SUITE 300
PENNSAUKEN NJ
08109-4613
US

IV. Provider business mailing address

2500 MCCLELLAN AVE SUITE 300
PENNSAUKEN NJ
08109-4613
US

V. Phone/Fax

Practice location:
  • Phone: 856-361-1106
  • Fax: 856-488-1450
Mailing address:
  • Phone: 856-361-1106
  • Fax: 856-488-1450

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: