Provider Demographics
NPI:1962863225
Name:WHITBY, CONNIE (SLPA)
Entity Type:Individual
Prefix:
First Name:CONNIE
Middle Name:
Last Name:WHITBY
Suffix:
Gender:F
Credentials:SLPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14105 SKYLINE DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDER
Mailing Address - State:AR
Mailing Address - Zip Code:72002-1824
Mailing Address - Country:US
Mailing Address - Phone:501-765-2911
Mailing Address - Fax:501-897-6195
Practice Address - Street 1:14105 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:ALEXANDER
Practice Address - State:AR
Practice Address - Zip Code:72002-1824
Practice Address - Country:US
Practice Address - Phone:501-765-2911
Practice Address - Fax:501-897-6195
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR#15-0262355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant