Provider Demographics
NPI:1154579381
Name:HILL, WHITNEY DICKERT (MSP)
Entity type:Individual
Prefix:
First Name:WHITNEY
Middle Name:DICKERT
Last Name:HILL
Suffix:
Gender:F
Credentials:MSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710B RICHLAND ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201-2636
Mailing Address - Country:US
Mailing Address - Phone:803-253-6223
Mailing Address - Fax:803-253-6224
Practice Address - Street 1:1710B RICHLAND ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-2636
Practice Address - Country:US
Practice Address - Phone:803-253-6223
Practice Address - Fax:803-253-6224
Is Sole Proprietor?:No
Enumeration Date:2008-08-29
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4360235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCSA1016Medicaid