Provider Demographics
NPI:1194023945
Name:WHITE, ELIZABETH ANN
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ANN
Last Name:WHITE
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 1:6 DENNIS DR
Mailing Address - Street 2:
Mailing Address - City:VILONIA
Mailing Address - State:AR
Mailing Address - Zip Code:72173-9709
Mailing Address - Country:US
Mailing Address - Phone:501-796-8671
Mailing Address - Fax:
Practice Address - Street 1:101 BULLDOG DR
Practice Address - Street 2:
Practice Address - City:PLUMERVILLE
Practice Address - State:AR
Practice Address - Zip Code:72127-8803
Practice Address - Country:US
Practice Address - Phone:501-354-2269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-03
Last Update Date:2011-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#1879235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist