Provider Demographics
NPI:1154170009
Name:WILEY, WHITNEY SIMONE (SLP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:SIMONE
Last Name:WILEY
Suffix:
Gender:
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 HIGHLANDS BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31407-4107
Mailing Address - Country:US
Mailing Address - Phone:803-236-2840
Mailing Address - Fax:
Practice Address - Street 1:335 OLD RAIL RD
Practice Address - Street 2:
Practice Address - City:BLOOMINGDALE
Practice Address - State:GA
Practice Address - Zip Code:31302-4025
Practice Address - Country:US
Practice Address - Phone:912-421-0140
Practice Address - Fax:440-556-6007
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GASLP013497235Z00000X, 235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist