Provider Demographics
NPI:1144401498
Name:WHITEHURST-BOAKYE, STACI MARIE (MS,CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:STACI
Middle Name:MARIE
Last Name:WHITEHURST-BOAKYE
Suffix:
Gender:F
Credentials:MS,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:197 THOMAS JOHNSON DR STE A-B
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4314
Mailing Address - Country:US
Mailing Address - Phone:866-727-3422
Mailing Address - Fax:
Practice Address - Street 1:197 THOMAS JOHNSON DR STE A-B
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4314
Practice Address - Country:US
Practice Address - Phone:866-727-3422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-15
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05198235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist