Provider Demographics
NPI:1508021478
Name:WITT, NANETTE MARIE (MHS-CCC/SLP)
Entity Type:Individual
Prefix:MRS
First Name:NANETTE
Middle Name:MARIE
Last Name:WITT
Suffix:
Gender:F
Credentials:MHS-CCC/SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17274 WHITE OAK AVE
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:IN
Mailing Address - Zip Code:46356-9463
Mailing Address - Country:US
Mailing Address - Phone:219-690-1051
Mailing Address - Fax:
Practice Address - Street 1:17274 WHITE OAK AVE
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:IN
Practice Address - Zip Code:46356-9463
Practice Address - Country:US
Practice Address - Phone:219-690-1051
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-21
Last Update Date:2008-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN22004036A235Z00000X
IL146.003787235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist