Provider Demographics
NPI:1699977108
Name:WHITE, NATALIE (SLP)
Entity type:Individual
Prefix:
First Name:NATALIE
Middle Name:
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 1:557 E FRONT ST
Mailing Address - Street 2:
Mailing Address - City:OWEGO
Mailing Address - State:NY
Mailing Address - Zip Code:13827-1232
Mailing Address - Country:US
Mailing Address - Phone:206-409-3468
Mailing Address - Fax:
Practice Address - Street 1:557 E FRONT ST
Practice Address - Street 2:
Practice Address - City:OWEGO
Practice Address - State:NY
Practice Address - Zip Code:13827-1232
Practice Address - Country:US
Practice Address - Phone:206-409-3468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALL00003817235Z00000X
NY030691235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY030691OtherSTATE SPEECH-LANGUAGE PATHOLOGIST LICENSE