Provider Demographics
NPI:1609239995
Name:WHITTLE, EBBONYE (MS, CCC/SLP)
Entity Type:Individual
Prefix:
First Name:EBBONYE
Middle Name:
Last Name:WHITTLE
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 1:15711 ECHO GLEN DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-7419
Mailing Address - Country:US
Mailing Address - Phone:903-440-4924
Mailing Address - Fax:
Practice Address - Street 1:100 E. FERGUSON
Practice Address - Street 2:SUITE 1204
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701
Practice Address - Country:US
Practice Address - Phone:903-440-4924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2016-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110008235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist