=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437480084
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER L. WHITE M.S., CCC-SLP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/21/2010
-----------------------------------------------------
Last Update Date | 01/21/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 801 5TH AVE SE
-----------------------------------------------------
City | DEVILS LAKE
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58301-3649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-662-2769
-----------------------------------------------------
Fax | 701-662-7684
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 801 5TH AVE SE
-----------------------------------------------------
City | DEVILS LAKE
-----------------------------------------------------
State | ND
-----------------------------------------------------
Zip | 58301-3649
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 701-662-2769
-----------------------------------------------------
Fax | 701-662-7684
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 235Z00000X
-----------------------------------------------------
Taxonomy Name | Speech-Language Pathologist
-----------------------------------------------------
License Number | 1058
-----------------------------------------------------
License Number State | ND
-----------------------------------------------------