Provider Demographics
NPI:1114225307
Name:WHITENER, GAIL BUCHANAN (M A CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:GAIL
Middle Name:BUCHANAN
Last Name:WHITENER
Suffix:
Gender:F
Credentials:M A CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:736 COACHLIGHT ROAD
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71106-7230
Mailing Address - Country:US
Mailing Address - Phone:318-869-2968
Mailing Address - Fax:
Practice Address - Street 1:736 COACHLIGHT ROAD
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71106-7230
Practice Address - Country:US
Practice Address - Phone:318-869-2968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-11
Last Update Date:2011-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09149609235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist