Provider Demographics
NPI:1811264245
Name:PFEIFER, WHITNEY JOHNSON (SLP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:JOHNSON
Last Name:PFEIFER
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 N CUMMINGS LN
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-9267
Mailing Address - Country:US
Mailing Address - Phone:309-886-2305
Mailing Address - Fax:309-444-3893
Practice Address - Street 1:1201 N CUMMINGS LN
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IL
Practice Address - Zip Code:61571-9267
Practice Address - Country:US
Practice Address - Phone:309-886-2305
Practice Address - Fax:309-444-3893
Is Sole Proprietor?:No
Enumeration Date:2011-11-30
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP01162437OtherRR MEDICARE
IL537460039Medicare PIN