Provider Demographics
NPI:1154515989
Name:WHITNEY, WAYNE LEE (BC-HIS)
Entity type:Individual
Prefix:MR
First Name:WAYNE
Middle Name:LEE
Last Name:WHITNEY
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12830 COX LN
Mailing Address - Street 2:PO BOX 367
Mailing Address - City:OSSEO
Mailing Address - State:WI
Mailing Address - Zip Code:54758-9004
Mailing Address - Country:US
Mailing Address - Phone:715-597-2683
Mailing Address - Fax:715-597-2683
Practice Address - Street 1:12830 COX LN
Practice Address - Street 2:
Practice Address - City:OSSEO
Practice Address - State:WI
Practice Address - Zip Code:54758-9004
Practice Address - Country:US
Practice Address - Phone:715-597-2683
Practice Address - Fax:715-597-2683
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI191237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42822400Medicaid