Provider Demographics
NPI:1952705188
Name:CERVANTEZ, WHITNEY ANN (MS SLP)
Entity Type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:ANN
Last Name:CERVANTEZ
Suffix:
Gender:F
Credentials:MS SLP
Other - Prefix:MRS
Other - First Name:WHITNEY
Other - Middle Name:ANN
Other - Last Name:CERVANTEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS
Mailing Address - Street 1:414 S WESLEY AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:61054-1428
Mailing Address - Country:US
Mailing Address - Phone:815-734-4103
Mailing Address - Fax:
Practice Address - Street 1:414 S WESLEY AVE
Practice Address - Street 2:
Practice Address - City:MOUNT MORRIS
Practice Address - State:IL
Practice Address - Zip Code:61054-1428
Practice Address - Country:US
Practice Address - Phone:815-734-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-17
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL242003038235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist