Healthcare Provider Details

I. General information

NPI: 1942592845
Provider Name (Legal Business Name): JESSICA ELAINE WHITE M.S. CCC-SLP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 12/29/2025
Certification Date: 12/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

628 SW 27TH ST
MOORE OK
73160-5521
US

IV. Provider business mailing address

628 SW 27TH ST
MOORE OK
73160-5521
US

V. Phone/Fax

Practice location:
  • Phone: 405-639-9180
  • Fax:
Mailing address:
  • Phone: 405-639-9180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235500000X
TaxonomySpeech/Language/Hearing Specialist/Technologist
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number3234
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: