Provider Demographics
NPI:1003224742
Name:SPITLER, DEWEY
Entity Type:Individual
Prefix:
First Name:DEWEY
Middle Name:
Last Name:SPITLER
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 1:1781 E STATE ROUTE 69
Mailing Address - Street 2:SUITE 65
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86301-5666
Mailing Address - Country:US
Mailing Address - Phone:928-227-2476
Mailing Address - Fax:
Practice Address - Street 1:1781 E STATE ROUTE 69
Practice Address - Street 2:SUITE 65
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-5666
Practice Address - Country:US
Practice Address - Phone:928-227-2476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-25
Last Update Date:2014-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZTHAD 8219237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist