Provider Demographics
NPI:1164524609
Name:WHIGHAM, SUSAN CLAIRE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:CLAIRE
Last Name:WHIGHAM
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 1:3806 FARMINGTON DR
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75082-2880
Mailing Address - Country:US
Mailing Address - Phone:214-642-8217
Mailing Address - Fax:
Practice Address - Street 1:3806 FARMINGTON DR
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75082-2880
Practice Address - Country:US
Practice Address - Phone:214-642-8217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist