Provider Demographics
NPI:1376264317
Name:MATTOX, WHITNEY LEA (SLP-CCC)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LEA
Last Name:MATTOX
Suffix:
Gender:F
Credentials:SLP-CCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:STATESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28677-5257
Mailing Address - Country:US
Mailing Address - Phone:704-775-4466
Mailing Address - Fax:704-775-4466
Practice Address - Street 1:125 W BROAD ST
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5257
Practice Address - Country:US
Practice Address - Phone:704-775-4466
Practice Address - Fax:704-775-4466
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-08
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15566235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist