Provider Demographics
NPI:1346540275
Name:WHITE, ENRIQUA (SLP, TSLD)
Entity Type:Individual
Prefix:MISS
First Name:ENRIQUA
Middle Name:
Last Name:WHITE
Suffix:
Gender:F
Credentials:SLP, TSLD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2736 COLDEN AVE
Mailing Address - Street 2:APT 3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10469
Mailing Address - Country:US
Mailing Address - Phone:646-391-9405
Mailing Address - Fax:
Practice Address - Street 1:2736 COLDEN AVE APT 3
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10469-4152
Practice Address - Country:US
Practice Address - Phone:646-391-9405
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019398235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY019398OtherNYS SPEECH PATHOLOGY LICENSE