Provider Demographics
NPI:1154625747
Name:WHITTAKER, ANNE M (SLP)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:WHITTAKER
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:PO BOX 260756
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33026-7756
Mailing Address - Country:US
Mailing Address - Phone:954-551-2574
Mailing Address - Fax:
Practice Address - Street 1:17670 NW 78TH AVE
Practice Address - Street 2:#113
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33015-3664
Practice Address - Country:US
Practice Address - Phone:305-512-5757
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSA5948235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL887605300Medicaid