Provider Demographics
NPI:1548897911
Name:SMITH, WHITEY WINDHAM
Entity type:Individual
Prefix:
First Name:WHITEY
Middle Name:WINDHAM
Last Name:SMITH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 KENNETH BLVD NW
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:AL
Mailing Address - Zip Code:35757-6953
Mailing Address - Country:US
Mailing Address - Phone:256-701-7984
Mailing Address - Fax:
Practice Address - Street 1:320 KENNETH BLVD NW
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:AL
Practice Address - Zip Code:35757-6953
Practice Address - Country:US
Practice Address - Phone:256-701-7984
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-25
Last Update Date:2020-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist