Provider Demographics
NPI:1629757695
Name:WHITE-MINNIS, LETITIA JEAN (PHD)
Entity type:Individual
Prefix:
First Name:LETITIA
Middle Name:JEAN
Last Name:WHITE-MINNIS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:LETITIA
Other - Middle Name:JEAN
Other - Last Name:WHITE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4501 E FARM ROAD 94
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-8366
Mailing Address - Country:US
Mailing Address - Phone:417-894-7050
Mailing Address - Fax:
Practice Address - Street 1:4501 E FARM ROAD 94
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-8366
Practice Address - Country:US
Practice Address - Phone:417-894-7050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009003221231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty