Provider Demographics
NPI:1740033927
Name:WHITMORE-GOVERS, LUCRETIA MARIE (CCC-SLP)
Entity type:Individual
Prefix:
First Name:LUCRETIA
Middle Name:MARIE
Last Name:WHITMORE-GOVERS
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12720 BROOKPARK RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-3137
Mailing Address - Country:US
Mailing Address - Phone:510-919-7013
Mailing Address - Fax:
Practice Address - Street 1:12720 BROOKPARK RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-3137
Practice Address - Country:US
Practice Address - Phone:510-919-7013
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24291235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist