Individual
MS. JENNIE L WHITAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.A. CCC-SLP
Contact information
Practice address
968 BAYOU TRACE DR, ALEXANDRIA, LA 71303-2554
(318) 308-4752
Mailing address
968 BAYOU TRACE DR, ALEXANDRIA, LA 71303-2554
(318) 308-4752
Taxonomy
Speciality
Code
Description
License number
State
235Z00000X
Speech-Language Pathologist
Primary
1644
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
JWHITAKER49
BLUE CROSS/ BLUE SHIELD
LA
05
—
JWHITAKER49
—
LA
Enumeration date
05/12/2009
Last updated
05/12/2009
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