Provider Demographics
NPI:1629749940
Name:SPEAKMAN, WHITNEY L (CT)
Entity Type:Individual
Prefix:
First Name:WHITNEY
Middle Name:L
Last Name:SPEAKMAN
Suffix:
Gender:F
Credentials:CT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 W MOUND ST
Mailing Address - Street 2:
Mailing Address - City:CIRCLEVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43113-1623
Mailing Address - Country:US
Mailing Address - Phone:740-601-9380
Mailing Address - Fax:
Practice Address - Street 1:105 W MOUND ST
Practice Address - Street 2:
Practice Address - City:CIRCLEVILLE
Practice Address - State:OH
Practice Address - Zip Code:43113-1623
Practice Address - Country:US
Practice Address - Phone:740-740-6019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-26
Last Update Date:2021-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC.2103517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health