Provider Demographics
NPI:1639428907
Name:WHITAKER, ERIN S (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:ERIN
Middle Name:S
Last Name:WHITAKER
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 1:503 E SEMINOLE PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74106-4327
Mailing Address - Country:US
Mailing Address - Phone:918-809-6996
Mailing Address - Fax:
Practice Address - Street 1:9224 S ELWOOD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:JENKS
Practice Address - State:OK
Practice Address - Zip Code:74037-2363
Practice Address - Country:US
Practice Address - Phone:918-409-0157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-02
Last Update Date:2012-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3526235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist