Provider Demographics
NPI:1407076870
Name:WHITEHOUSE, EMILY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:EMILY
Middle Name:
Last Name:WHITEHOUSE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 BIRCH CIR
Mailing Address - Street 2:
Mailing Address - City:PEARL CITY
Mailing Address - State:HI
Mailing Address - Zip Code:96782-2506
Mailing Address - Country:US
Mailing Address - Phone:907-903-7762
Mailing Address - Fax:
Practice Address - Street 1:545 BIRCH CIR
Practice Address - Street 2:
Practice Address - City:PEARL CITY
Practice Address - State:HI
Practice Address - Zip Code:96782-2506
Practice Address - Country:US
Practice Address - Phone:907-903-7762
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-26
Last Update Date:2010-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARSP#2450235Z00000X
AK232235Z00000X
HI1099235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR519921721Medicaid