Provider Demographics
NPI:1184179137
Name:WHITAKER, CHERYL
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40500 SEELY RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MS
Mailing Address - Zip Code:39746-9700
Mailing Address - Country:US
Mailing Address - Phone:662-436-5180
Mailing Address - Fax:
Practice Address - Street 1:40500 SEELY RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MS
Practice Address - Zip Code:39746-9700
Practice Address - Country:US
Practice Address - Phone:662-436-5180
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-19
Last Update Date:2016-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS3002235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist