Provider Demographics
NPI:1831255694
Name:WHITE, LAQUETTA ANNETTE (SLP)
Entity type:Individual
Prefix:
First Name:LAQUETTA
Middle Name:ANNETTE
Last Name:WHITE
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:LAQUETTA
Other - Middle Name:ANNETTE
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4481 DUNMOVIN DR NW
Mailing Address - Street 2:
Mailing Address - City:KENNESAW
Mailing Address - State:GA
Mailing Address - Zip Code:30144-1316
Mailing Address - Country:US
Mailing Address - Phone:770-926-2884
Mailing Address - Fax:678-269-8414
Practice Address - Street 1:4481 DUNMOVIN DR NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30144-1316
Practice Address - Country:US
Practice Address - Phone:770-926-2884
Practice Address - Fax:678-269-8414
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA4436235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist