Provider Demographics
NPI:1851063747
Name:WHITEHEAD, CHRISTIAN MORGAN (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:CHRISTIAN
Middle Name:MORGAN
Last Name:WHITEHEAD
Suffix:
Gender:F
Credentials: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:PO BOX 16901
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39404-6901
Mailing Address - Country:US
Mailing Address - Phone:601-297-7023
Mailing Address - Fax:
Practice Address - Street 1:91 WILLIAMS RD
Practice Address - Street 2:
Practice Address - City:SEMINARY
Practice Address - State:MS
Practice Address - Zip Code:39479-9009
Practice Address - Country:US
Practice Address - Phone:601-297-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSS4589235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist