Provider Demographics
NPI:1083746192
Name:WHYTLAW, NATALIE REAGAN (MSCCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:NATALIE
Middle Name:REAGAN
Last Name:WHYTLAW
Suffix:
Gender:F
Credentials:MSCCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 GARDEN LN
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:TX
Mailing Address - Zip Code:79761-3518
Mailing Address - Country:US
Mailing Address - Phone:432-272-0937
Mailing Address - Fax:
Practice Address - Street 1:620 N ALLEGHANEY AVE
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:TX
Practice Address - Zip Code:79761-4408
Practice Address - Country:US
Practice Address - Phone:432-332-8244
Practice Address - Fax:432-580-7428
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100252235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8T2673OtherBCBS PROVIDER NUMBER
TX100252OtherSTATE LICENSE NUMBER
TX132534OtherSUPERIOR PROVIDER NUMBER