Provider Demographics
NPI:1649696154
Name:WHITMORE, MARY (SPEECH THERAPIST)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:WHITMORE
Suffix:
Gender:F
Credentials:SPEECH THERAPIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 700
Mailing Address - Street 2:DEWITT
Mailing Address - City:DE WITT
Mailing Address - State:AR
Mailing Address - Zip Code:72042-0700
Mailing Address - Country:US
Mailing Address - Phone:870-946-3576
Mailing Address - Fax:
Practice Address - Street 1:1841 S GRANDVIEW DR
Practice Address - Street 2:DEWITT
Practice Address - City:DE WITT
Practice Address - State:AR
Practice Address - Zip Code:72042-3450
Practice Address - Country:US
Practice Address - Phone:870-946-3576
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-07
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist