Provider Demographics
NPI:1649336025
Name:WHITE, TARYN MICHELLE (MED, CCC-SLP)
Entity type:Individual
Prefix:MS
First Name:TARYN
Middle Name:MICHELLE
Last Name:WHITE
Suffix:
Gender:F
Credentials:MED, 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:P.O. BOX 5152
Mailing Address - Street 2:
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27113-5152
Mailing Address - Country:US
Mailing Address - Phone:336-972-2216
Mailing Address - Fax:336-725-3590
Practice Address - Street 1:2325 DUNBAR ST
Practice Address - Street 2:
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27105
Practice Address - Country:US
Practice Address - Phone:336-972-2216
Practice Address - Fax:336-725-3590
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6087235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7412427Medicaid