Basic Information
| Provider Information | |||||||||
| NPI: | 1790117430 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARGROVE | ||||||||
| FirstName: | WHITNEY | ||||||||
| MiddleName: | KELLY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 601 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | IDALOU | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793294044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8068921900 | ||||||||
| FaxNumber: | 8067661286 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 WALNUT ST | ||||||||
| Address2: | |||||||||
| City: | IDALOU | ||||||||
| State: | TX | ||||||||
| PostalCode: | 793294044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5756312273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2013 | ||||||||
| LastUpdateDate: | 09/02/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/02/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 235Z00000X | 107945 | TX | Y | Speech, Language and Hearing Service Providers | Speech-Language Pathologist |
No ID Information.