Provider Demographics
NPI:1558008490
Name:WHITAKER, TYNASHIA DEYONA (SLP-ASSISTANT)
Entity Type:Individual
Prefix:
First Name:TYNASHIA
Middle Name:DEYONA
Last Name:WHITAKER
Suffix:
Gender:F
Credentials:SLP-ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1508 CIRCLE ST
Mailing Address - Street 2:
Mailing Address - City:TARBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27886-3407
Mailing Address - Country:US
Mailing Address - Phone:252-314-2277
Mailing Address - Fax:
Practice Address - Street 1:1875 POST OAK PARK DR APT 211
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77027-3463
Practice Address - Country:US
Practice Address - Phone:252-314-2277
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-12
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant