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General NPI Number Information
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NPI Number | 1467007138
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Entity Type | Individual
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Provider Name | KANADA BRELANE WHITE M.S., CCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 08/08/2019
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Last Update Date | 04/17/2023
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Provider Practice Location Address
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Address Line | 5214 THOMASON DR
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City | MIDLAND
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State | TX
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Zip | 79703-6000
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Country | US
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Telephone | 432-699-1261
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Fax |
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Provider Business Mailing Address
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Address Line | 1216 BURGANDY DR
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City | MIDLAND
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State | TX
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Zip | 79705-4485
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Country | US
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Telephone | 432-634-2786
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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 | 115848
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License Number State | TX
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