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General NPI Number Information
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NPI Number | 1821203886
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Entity Type | Individual
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Provider Name | GAIL LYNN WHITLOCK MSCCC-SLP
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Gender | Female
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Dates
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Enumeration Date | 05/13/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3431 N 13TH ST
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City | SHEBOYGAN
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State | WI
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Zip | 53083-2938
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Country | US
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Telephone | 920-457-5046
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Fax |
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Provider Business Mailing Address
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Address Line | 1417 EISNER AVE APT G1
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City | SHEBOYGAN
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State | WI
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Zip | 53083-2974
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Country | US
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Telephone | 920-458-4904
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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 | 1487-154
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License Number State | WI
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