Provider Demographics
NPI:1285361030
Name:WHITE, ERIN LEE (SLP)
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:LEE
Last Name:WHITE
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 1:4761 WESTWIND AVE
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-9298
Mailing Address - Country:US
Mailing Address - Phone:505-860-3250
Mailing Address - Fax:
Practice Address - Street 1:1204 CAMINA HERMOSA
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-8137
Practice Address - Country:US
Practice Address - Phone:505-599-8603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSLP4983235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist