Provider Demographics
NPI:1124476940
Name:COLLIER, WHITLEY CAYLIN (SLP)
Entity type:Individual
Prefix:
First Name:WHITLEY
Middle Name:CAYLIN
Last Name:COLLIER
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 1:629 PHOENIX DR STE 115
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-7392
Mailing Address - Country:US
Mailing Address - Phone:757-261-4475
Mailing Address - Fax:
Practice Address - Street 1:629 PHOENIX DR STE 115
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-7392
Practice Address - Country:US
Practice Address - Phone:757-261-4475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-02
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373572355S0801X
VA2202010146235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant