Provider Demographics
NPI:1629214267
Name:WHITE, TAMEKA C (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TAMEKA
Middle Name:C
Last Name:WHITE
Suffix:
Gender:F
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3725 PRINCETON LAKES PKWY SW
Mailing Address - Street 2:APT 9109
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30331-5532
Mailing Address - Country:US
Mailing Address - Phone:404-917-4352
Mailing Address - Fax:
Practice Address - Street 1:18833 TOWN RIDGE LN APT 2202
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:TX
Practice Address - Zip Code:77598-1625
Practice Address - Country:US
Practice Address - Phone:404-917-4352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-04
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114167OtherTEXAS DEPARTMENT OF LICENSURE