Provider Demographics
NPI:1073242327
Name:ENNACO, WHITNEY (SLP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:
Last Name:ENNACO
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:WHITNEY
Other - Middle Name:
Other - Last Name:FORT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1804 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91803-3419
Mailing Address - Country:US
Mailing Address - Phone:760-797-5135
Mailing Address - Fax:
Practice Address - Street 1:5401 WALL PRICE KELLER RD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76244-7109
Practice Address - Country:US
Practice Address - Phone:760-797-5135
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX119401235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist