Demetria Collins-Whitaker, CCC-SLP/L

Primary specialty

Speech-Language PathologistTaxonomy code 235Z00000X

License

146.009035 Issued in IL

Practice address

3718 213TH PL
Matteson, IL 60443-2575

Phone

(708) 748-0470

NPI assigned

Mar 27, 2007

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1174953600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1684281600000",
    "number": "1740308816",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3718 213TH PL",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432575",
            "telephone_number": "708-748-0470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3718 213TH PL",
            "city": "MATTESON",
            "state": "IL",
            "postal_code": "604432575",
            "telephone_number": "708-748-0470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COLLINS-WHITAKER",
        "first_name": "DEMETRIA",
        "credential": "CCC-SLP/L",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-03-27",
        "last_updated": "2023-05-17",
        "certification_date": "2023-05-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "242000261",
            "primary": false
        },
        {
            "code": "235Z00000X",
            "taxonomy_group": "",
            "desc": "Speech-Language Pathologist",
            "state": "IL",
            "license": "146.009035",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "dwhitaker@sd162.org",
            "affiliation": "N",
            "address_1": "3718 213th Pl",
            "city": "Matteson",
            "state": "IL",
            "country_code": "US",
            "postal_code": "604432575",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Speech-Language Pathologist in Matteson, IL
• Providers in Matteson, IL by specialty
• Speech-Language Pathologist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 17, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.