Provider Demographics
NPI:1619272432
Name:WHITLATCH, DENELLE MARIE (MA, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:DENELLE
Middle Name:MARIE
Last Name:WHITLATCH
Suffix:
Gender:F
Credentials:MA, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3008 WHEATFIELD LN
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:IL
Mailing Address - Zip Code:62293-3601
Mailing Address - Country:US
Mailing Address - Phone:618-660-8416
Mailing Address - Fax:618-224-6132
Practice Address - Street 1:3008 WHEATFIELD LN
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:IL
Practice Address - Zip Code:62293-3601
Practice Address - Country:US
Practice Address - Phone:618-660-8416
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-26
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146010344235Z00000X
MO2010017184235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist