Provider Demographics
NPI:1790976959
Name:WHITTLE, QUINCY NYE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:QUINCY
Middle Name:NYE
Last Name:WHITTLE
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:QUINCY
Other - Middle Name:
Other - Last Name:WHITTLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:603 RAINBOW CREEK CT
Mailing Address - Street 2:SUITE T05
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-6207
Mailing Address - Country:US
Mailing Address - Phone:803-429-6907
Mailing Address - Fax:
Practice Address - Street 1:603 RAINBOW CREEK CT
Practice Address - Street 2:SUITE T05
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-6207
Practice Address - Country:US
Practice Address - Phone:803-429-6907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2014-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3599235Z00000X
TX108660235Z00000X
KY3680235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist