Provider Demographics
NPI:1922419795
Name:WHITE, MERCEDES GARCIA (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:GARCIA
Last Name:WHITE
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 1:2367 S XANADU WAY
Mailing Address - Street 2:#207
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-6057
Mailing Address - Country:US
Mailing Address - Phone:512-466-2616
Mailing Address - Fax:
Practice Address - Street 1:2367 S XANADU WAY
Practice Address - Street 2:#207
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-6057
Practice Address - Country:US
Practice Address - Phone:512-466-2616
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-15
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1549235Z00000X
CO98294235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist