Provider Demographics
NPI:1043408867
Name:WELLBORN, WHITNEY
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:
Last Name:WELLBORN
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 1:198 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-8944
Mailing Address - Country:US
Mailing Address - Phone:828-964-9111
Mailing Address - Fax:
Practice Address - Street 1:322 NUWAY CIR
Practice Address - Street 2:
Practice Address - City:LENOIR
Practice Address - State:NC
Practice Address - Zip Code:28645-3656
Practice Address - Country:US
Practice Address - Phone:828-754-8500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-05
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225500000X
NC7291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225500000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/Technologist
No235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist