Provider Demographics
NPI:1508853920
Name:WHITAKER, COURTNEY LYNN (BA/SLP)
Entity Type:Individual
Prefix:MRS
First Name:COURTNEY
Middle Name:LYNN
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:BA/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22214 SHORESIDE DR
Mailing Address - Street 2:
Mailing Address - City:LAND O LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:34639-4615
Mailing Address - Country:US
Mailing Address - Phone:813-335-1173
Mailing Address - Fax:813-996-9691
Practice Address - Street 1:22214 SHORESIDE DR
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-4615
Practice Address - Country:US
Practice Address - Phone:813-335-1173
Practice Address - Fax:813-996-9691
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2010-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSI9292355S0801X
FL222Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist