Healthcare Provider Details

I. General information

NPI: 1023926060
Provider Name (Legal Business Name): JENNIFER WHITE M.S., CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 N CASS LAKE RD
WATERFORD MI
48328-2307
US

IV. Provider business mailing address

501 N CASS LAKE RD
WATERFORD MI
48328-2307
US

V. Phone/Fax

Practice location:
  • Phone: 248-674-2412
  • Fax:
Mailing address:
  • Phone: 248-674-2412
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number235Z00000X
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: