Provider Demographics
NPI:1659597821
Name:WITHAM, JAMES TODD (SLP)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:TODD
Last Name:WITHAM
Suffix:
Gender:M
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20268 LITTLE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-7937
Mailing Address - Country:US
Mailing Address - Phone:317-877-7017
Mailing Address - Fax:
Practice Address - Street 1:10585 N MERIDIAN ST STE 201
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46290-1067
Practice Address - Country:US
Practice Address - Phone:317-815-0778
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22002890A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist