Provider Demographics
NPI:1699145938
Name:MOONEY, WHITNEY JADE POWELL (MS CCC-SLP)
Entity type:Individual
Prefix:MRS
First Name:WHITNEY
Middle Name:JADE POWELL
Last Name:MOONEY
Suffix:
Gender:F
Credentials:MS CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8093 CYPRESSTREE LN
Mailing Address - Street 2:
Mailing Address - City:MECHANICSVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:23111-4616
Mailing Address - Country:US
Mailing Address - Phone:434-962-5518
Mailing Address - Fax:
Practice Address - Street 1:3600 MOUNTAIN RD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-1930
Practice Address - Country:US
Practice Address - Phone:804-672-8725
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-29
Last Update Date:2015-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA2202006310235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist