Provider Demographics
NPI:1063487833
Name:WHITE, S DAVID (MA, CCC-SLP)
Entity Type:Individual
Prefix:MR
First Name:S DAVID
Middle Name:
Last Name:WHITE
Suffix:
Gender:M
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 1:250 PEEBLES HILL RD
Mailing Address - Street 2:
Mailing Address - City:ONEONTA
Mailing Address - State:NY
Mailing Address - Zip Code:13820-3601
Mailing Address - Country:US
Mailing Address - Phone:607-547-3167
Mailing Address - Fax:607-547-3413
Practice Address - Street 1:250 PEEBLES HILL RD
Practice Address - Street 2:
Practice Address - City:ONEONTA
Practice Address - State:NY
Practice Address - Zip Code:13820-3601
Practice Address - Country:US
Practice Address - Phone:607-547-3167
Practice Address - Fax:607-547-3413
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-23
Last Update Date:2009-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY5467170235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000000100551OtherGHI
NY10101786OtherCDPHP
NY7309713OtherAETNA