MEDICARE: DALE D WHITMA MA, CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP784	NV

General Provider Information

NPI Number	:	1538460217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DALE D WHITMA MA, CCC-SLP

Provider Business Mailing Address
First Line	:	358 BROKEN PAR DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5211
Country	:	US
Telephone Number	:	702-672-6050
Fax Number	:

Provider Business Practice Location Address
First Line	:	358 BROKEN PAR DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-5211
Country	:	US
Telephone Number	:	702-672-6050
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2010
Last Update Date	:	11/11/2010

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Directions to “ DALE D WHITMA MA, CCC-SLP” Practice Location

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