Provider Demographics
NPI:1730484346
Name:WHITED, JENNIFER SEWARD (JENNIFER WHITED)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SEWARD
Last Name:WHITED
Suffix:
Gender:F
Credentials:JENNIFER WHITED
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:ELAINE
Other - Last Name:SEWARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:JENNIFER WHITED
Mailing Address - Street 1:810 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71203-2917
Mailing Address - Country:US
Mailing Address - Phone:337-207-7997
Mailing Address - Fax:
Practice Address - Street 1:810 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-2917
Practice Address - Country:US
Practice Address - Phone:337-207-7997
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2011-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA5791235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist