MEDICARE: EMILY NICOLE WHITING M.S., 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	SLP.0006079	CO
2	235Z00000X	Speech-Language Pathologist	30004396	NC

General Provider Information

NPI Number	:	1558138404
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY NICOLE WHITING M.S., CCC-SLP

Provider Business Mailing Address
First Line	:	2604 FALLS RIVER AVE
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-9875
Country	:	US
Telephone Number	:	651-239-7881
Fax Number	:	984-272-2849

Provider Business Practice Location Address
First Line	:	3041 BERKS WAY STE 203
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27614-6777
Country	:	US
Telephone Number	:	919-488-4009
Fax Number	:	984-272-2849

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

Provider Enumeration Date	:	12/11/2023
Last Update Date	:	12/19/2025

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Directions to “ EMILY NICOLE WHITING M.S., CCC-SLP” Practice Location

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