Provider Demographics
NPI:1093043523
Name:DUTTON, WENDY L (DAOM, LAC)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:L
Last Name:DUTTON
Suffix:
Gender:F
Credentials:DAOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1153 BERGEN PKWY
Mailing Address - Street 2:SUITE I PMB 174
Mailing Address - City:EVERGREEN
Mailing Address - State:CO
Mailing Address - Zip Code:80439
Mailing Address - Country:US
Mailing Address - Phone:719-960-9890
Mailing Address - Fax:
Practice Address - Street 1:45 COUNTY ROAD 68
Practice Address - Street 2:
Practice Address - City:BAILEY
Practice Address - State:CO
Practice Address - Zip Code:80421
Practice Address - Country:US
Practice Address - Phone:719-960-9890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-20
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CONCC168480171100000X
246ZC0007X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant
Yes171100000XOther Service ProvidersAcupuncturist