Provider Demographics
NPI:1154449130
Name:LEARY, WHITNEY CONNOLLY (MSP, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:CONNOLLY
Last Name:LEARY
Suffix:
Gender:F
Credentials:MSP, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 SEATTLE SLEW PL
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:SC
Mailing Address - Zip Code:29745-6430
Mailing Address - Country:US
Mailing Address - Phone:803-628-1198
Mailing Address - Fax:
Practice Address - Street 1:720 A SOUTH DUNCAN BYPASS
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:SC
Practice Address - Zip Code:29379
Practice Address - Country:US
Practice Address - Phone:864-429-3003
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3611235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist