Provider Demographics
NPI:1689923872
Name:WHITE, KATHLEEN SHERYLL (MHS, CCC/SLP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:SHERYLL
Last Name:WHITE
Suffix:
Gender:F
Credentials:MHS, CCC/SLP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:SHERYLL
Other - Last Name:HARRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 CARNEGIE PLZ
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-1000
Mailing Address - Country:US
Mailing Address - Phone:877-407-3422
Mailing Address - Fax:855-870-0438
Practice Address - Street 1:7 CARNEGIE PLZ
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-1000
Practice Address - Country:US
Practice Address - Phone:877-407-3422
Practice Address - Fax:855-870-0438
Is Sole Proprietor?:No
Enumeration Date:2012-09-04
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE01-0000855235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist