Basic Information
Provider Information
NPI: 1003010778
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PENDLETON-WHITE
FirstName: ANNE
MiddleName: Z.
NamePrefix: MRS.
NameSuffix:  
Credential: SLP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1829 E FRANKLIN ST
Address2: BLDG. # 600
City: CHAPEL HILL
State: NC
PostalCode: 275145861
CountryCode: US
TelephoneNumber: 9199683456
FaxNumber: 9199323456
Practice Location
Address1: 1829 E FRANKLIN ST
Address2: BLDG. # 600
City: CHAPEL HILL
State: NC
PostalCode: 275145861
CountryCode: US
TelephoneNumber: 9199683456
FaxNumber: 9199323456
Other Information
ProviderEnumerationDate: 06/14/2007
LastUpdateDate: 07/09/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
235Z00000X2123NCY Speech, Language and Hearing Service ProvidersSpeech-Language Pathologist 

ID Information
IDTypeStateIssuerDescription
741217105NC MEDICAID
137EM01NCBLUE CROSSOTHER


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