Provider Demographics
NPI:1457979502
Name:WHITMAN, TERAH (CCC-SLP)
Entity type:Individual
Prefix:
First Name:TERAH
Middle Name:
Last Name:WHITMAN
Suffix:
Gender:
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:926 W MOORE AVE
Mailing Address - Street 2:
Mailing Address - City:CYRIL
Mailing Address - State:OK
Mailing Address - Zip Code:73029-8000
Mailing Address - Country:US
Mailing Address - Phone:704-962-6836
Mailing Address - Fax:
Practice Address - Street 1:926 W MOORE AVE
Practice Address - Street 2:
Practice Address - City:CYRIL
Practice Address - State:OK
Practice Address - Zip Code:73029-8000
Practice Address - Country:US
Practice Address - Phone:704-962-6836
Practice Address - Fax:405-610-1910
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5290235Z00000X
NC14610235Z00000X
UT12425960-4102235Z00000X
SC7962235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist