Provider Demographics
NPI:1982132981
Name:WHITTLE SERVICES LLC
Entity type:Organization
Organization Name:WHITTLE SERVICES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.S.,CCC/SLP
Authorized Official - Prefix:
Authorized Official - First Name:EBBONYE
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITTLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:903-440-4924
Mailing Address - Street 1:1609 SOUTHPOINT DR
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-4548
Mailing Address - Country:US
Mailing Address - Phone:903-440-4924
Mailing Address - Fax:903-440-4924
Practice Address - Street 1:1609 SOUTHPOINT DR
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4548
Practice Address - Country:US
Practice Address - Phone:903-440-4924
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-02
Last Update Date:2017-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX110008235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language PathologistGroup - Multi-Specialty