Provider Demographics
NPI:1144668567
Name:WHITNER, DOROTHY R
Entity type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:R
Last Name:WHITNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 POWDERSVILLE MAIN
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29642-9354
Mailing Address - Country:US
Mailing Address - Phone:864-269-4571
Mailing Address - Fax:864-269-6701
Practice Address - Street 1:535 POWDERSVILLE MAIN
Practice Address - Street 2:
Practice Address - City:EASLEY
Practice Address - State:SC
Practice Address - Zip Code:29642-9354
Practice Address - Country:US
Practice Address - Phone:864-269-4571
Practice Address - Fax:864-269-6701
Is Sole Proprietor?:No
Enumeration Date:2013-06-07
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC101181235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1104973577Medicaid