Provider Demographics
NPI:1750654125
Name:WHITTED, LIDIA (MSSLP)
Entity Type:Individual
Prefix:MRS
First Name:LIDIA
Middle Name:
Last Name:WHITTED
Suffix:
Gender:F
Credentials:MSSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 BALDWIN PLACE RD
Mailing Address - Street 2:
Mailing Address - City:MAHOPAC
Mailing Address - State:NY
Mailing Address - Zip Code:10541-2212
Mailing Address - Country:US
Mailing Address - Phone:914-391-7926
Mailing Address - Fax:
Practice Address - Street 1:107 BALDWIN PLACE RD
Practice Address - Street 2:
Practice Address - City:MAHOPAC
Practice Address - State:NY
Practice Address - Zip Code:10541-2212
Practice Address - Country:US
Practice Address - Phone:914-391-7926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020722235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist