Provider Demographics
NPI:1467265397
Name:CLUCK, WHITNEY LYNN (HIS)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:LYNN
Last Name:CLUCK
Suffix:
Gender:F
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3401 ROGERS AVE STE C
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72903-2986
Mailing Address - Country:US
Mailing Address - Phone:479-782-7677
Mailing Address - Fax:
Practice Address - Street 1:3401 ROGERS AVE STE C
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72903-2986
Practice Address - Country:US
Practice Address - Phone:479-782-7677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR693237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist