Provider Demographics
NPI:1053518183
Name:WHITEHEAD, BARRY (MS, CCC-SLP)
Entity type:Individual
Prefix:MR
First Name:BARRY
Middle Name:
Last Name:WHITEHEAD
Suffix:
Gender:M
Credentials:MS, CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 OAKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-9757
Mailing Address - Country:US
Mailing Address - Phone:410-726-1116
Mailing Address - Fax:
Practice Address - Street 1:121 OAKWOOD DR
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-9757
Practice Address - Country:US
Practice Address - Phone:410-726-1116
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2238235Z00000X
MD656463235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2238OtherLICENSE
MD656463OtherLICENSE