Provider Demographics
NPI:1194446245
Name:WHITNEY, MADISON (MHS, CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:MADISON
Middle Name:
Last Name:WHITNEY
Suffix:
Gender:F
Credentials:MHS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 HAZELWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-2964
Mailing Address - Country:US
Mailing Address - Phone:660-441-4261
Mailing Address - Fax:
Practice Address - Street 1:3 MCKNIGHT PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1900
Practice Address - Country:US
Practice Address - Phone:314-993-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-07
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019021606235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist