Provider Demographics
NPI:1679725121
Name:BALENTINE, WHITNEY RAE (MS, CCC-SLP)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:RAE
Last Name:BALENTINE
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 1:820 S MACARTHUR BLVD STE 105-211
Mailing Address - Street 2:
Mailing Address - City:COPPELL
Mailing Address - State:TX
Mailing Address - Zip Code:75019-4216
Mailing Address - Country:US
Mailing Address - Phone:972-745-4524
Mailing Address - Fax:
Practice Address - Street 1:820 S MACARTHUR BLVD STE 105-211
Practice Address - Street 2:
Practice Address - City:COPPELL
Practice Address - State:TX
Practice Address - Zip Code:75019-4216
Practice Address - Country:US
Practice Address - Phone:972-745-4524
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102591235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist