Provider Demographics
NPI:1790162659
Name:ENSOR, WHITNEY (MS, CCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:WHITNEY
Middle Name:
Last Name:ENSOR
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 1:9600 CONSTELLATION BLVD
Mailing Address - Street 2:APT 6210
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76108-7616
Mailing Address - Country:US
Mailing Address - Phone:325-234-4252
Mailing Address - Fax:
Practice Address - Street 1:9600 CONSTELLATION BLVD
Practice Address - Street 2:APT 6210
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76108-7616
Practice Address - Country:US
Practice Address - Phone:325-234-4252
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-29
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX108819235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist