Provider Demographics
NPI:1205377884
Name:THOMPSON, WHITNEY JAI (MA,CCC-SLP)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:JAI
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA,CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1558 IVANS LN
Mailing Address - Street 2:
Mailing Address - City:BENNETTSVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29512-7636
Mailing Address - Country:US
Mailing Address - Phone:843-862-9582
Mailing Address - Fax:
Practice Address - Street 1:122 BROAD ST
Practice Address - Street 2:
Practice Address - City:BENNETTSVILLE
Practice Address - State:SC
Practice Address - Zip Code:29512-4002
Practice Address - Country:US
Practice Address - Phone:843-862-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5754235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist