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General NPI Number Information
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NPI Number | 1295251544
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Entity Type | Individual
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Provider Name | MELANIE JO WHITMORE
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Gender | Female
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Dates
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Enumeration Date | 08/18/2017
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Last Update Date | 08/18/2017
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Provider Practice Location Address
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Address Line | 1854 E BROADWAY
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City | ALTON
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State | IL
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Zip | 62002-6664
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Country | US
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Telephone | 618-474-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 8712 WILDEWOOD DR
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City | WORDEN
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State | IL
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Zip | 62097-1227
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Country | US
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Telephone | 618-459-3384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 235Z00000X
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Taxonomy Name | Speech-Language Pathologist
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License Number | 146.006695
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License Number State |
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