Provider Demographics
NPI:1336276963
Name:WHITE, RHONDA RENEE (CCC SLP)
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:RENEE
Last Name:WHITE
Suffix:
Gender:F
Credentials:CCC SLP
Other - Prefix:
Other - First Name:RHONDA
Other - Middle Name:R
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:803 EAST HIGHWAY 72
Mailing Address - Street 2:
Mailing Address - City:FREDERICKTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:63645-7292
Mailing Address - Country:US
Mailing Address - Phone:573-783-8001
Mailing Address - Fax:573-735-7045
Practice Address - Street 1:803 EAST HIGHWAY 72
Practice Address - Street 2:
Practice Address - City:FREDERICKTOWN
Practice Address - State:MO
Practice Address - Zip Code:63645-7292
Practice Address - Country:US
Practice Address - Phone:573-783-8001
Practice Address - Fax:573-735-7045
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2009-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2001022554235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO465189520Medicaid