Provider Demographics
NPI:1831307263
Name:WHITE, JESSIE GOODE (SPEECH LANG PATH)
Entity Type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:GOODE
Last Name:WHITE
Suffix:
Gender:F
Credentials:SPEECH LANG PATH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4902 EUCLID AVE
Mailing Address - Street 2:
Mailing Address - City:EAST CHICAGO
Mailing Address - State:IN
Mailing Address - Zip Code:46312-3743
Mailing Address - Country:US
Mailing Address - Phone:219-398-1292
Mailing Address - Fax:
Practice Address - Street 1:1000 114TH ST
Practice Address - Street 2:
Practice Address - City:WHITING
Practice Address - State:IN
Practice Address - Zip Code:46394-1048
Practice Address - Country:US
Practice Address - Phone:219-659-2770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22000301A235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist