Provider Demographics
NPI:1033307459
Name:WHITE, GENTRY A (MA CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GENTRY
Middle Name:A
Last Name:WHITE
Suffix:
Gender:F
Credentials:MA CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1127 E 570TH AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-8550
Mailing Address - Country:US
Mailing Address - Phone:620-232-2990
Mailing Address - Fax:620-232-2844
Practice Address - Street 1:1127 E 570TH AVE
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-8550
Practice Address - Country:US
Practice Address - Phone:620-232-2990
Practice Address - Fax:620-232-2844
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-10
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS2237235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist