Provider Demographics
NPI:1083183016
Name:WHITE, UMENIA MARIE (SPED TEACHER)
Entity Type:Individual
Prefix:
First Name:UMENIA
Middle Name:MARIE
Last Name:WHITE
Suffix:
Gender:F
Credentials:SPED TEACHER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7726 W. CENTER STREET
Mailing Address - Street 2:AOT 1
Mailing Address - City:MILW
Mailing Address - State:WI
Mailing Address - Zip Code:53222
Mailing Address - Country:US
Mailing Address - Phone:414-763-6676
Mailing Address - Fax:
Practice Address - Street 1:7726 W. CENTER STREET
Practice Address - Street 2:APT 1
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53222
Practice Address - Country:US
Practice Address - Phone:414-763-6676
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1590032736385HR2060X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child