Doctor Name: | MS. STACI MARIE WHITEHURST |
NPI Number: | 1144401498 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | M.S.,CCC-SLP |
License Number: | 05198 |
Business Practice Address: | 1 Independent Dr Jacksonville, FL - 322025039 |
Business Phone Number: | 8008495502 |
Business Fax Number: | |
Mailing Address: | 591 Cascade Way, FREDERICK |
State: | MD |
Postal Code: | 217036211 |
Phone Number: | 3013059934 |
Fax Number: | |
NPI Enumeration Date: | 11/15/2007 |
NPI Last Update Date: | 11/15/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 235Z00000X |
License Number: | 05198 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MD |
Taxonomy Type: | Speech, Language and Hearing Service Providers |
Taxonomy Classification: | Speech-Language Pathologist |
Taxonomy Specialization: | |
Taxonomy Definition: | A speech pathologist is a person qualified by a master |