Provider Demographics
NPI:1457979502
Name:WHITMAN, TERAH (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:TERAH
Middle Name:
Last Name:WHITMAN
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 1:14715 BRISTOL PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-1894
Mailing Address - Country:US
Mailing Address - Phone:405-840-1686
Mailing Address - Fax:405-840-1686
Practice Address - Street 1:926 W MOORE AVE
Practice Address - Street 2:
Practice Address - City:CYRIL
Practice Address - State:OK
Practice Address - Zip Code:73029-8000
Practice Address - Country:US
Practice Address - Phone:704-962-6836
Practice Address - Fax:405-610-1910
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5290235Z00000X
MA100280235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist