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NPI Code Detail

MEDICARE: MRS. JAN L. WHITUS SLP-CCC

MEDICARE: MRS. JAN L. WHITUS SLP-CCC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1235Z00000XSpeech-Language Pathologist2202001244VA

General Provider Information

NPI Number : 1487787586
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JAN L. WHITUS SLP-CCC
Provider Business Mailing Address
First Line : 2434 BLUE CASTLE CT
Second Line :
City : VIRGINIA BEACH
State : VA
Zip : 23454-1920
Country : US
Telephone Number : 757-412-0031
Fax Number : 757-461-1909
Provider Business Practice Location Address
First Line : 1309 KEMPSVILLE RD
Second Line :
City : NORFOLK
State : VA
Zip : 23502-2205
Country : US
Telephone Number : 757-461-5001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 07/08/2007

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