Provider Demographics
NPI:1114563202
Name:WHITTREDGE, DOROTHY K (MA)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:K
Last Name:WHITTREDGE
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1279 ROAD 310
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:KS
Mailing Address - Zip Code:66833-9323
Mailing Address - Country:US
Mailing Address - Phone:785-409-1530
Mailing Address - Fax:
Practice Address - Street 1:3084 N MAIZE RD
Practice Address - Street 2:HAC
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-7359
Practice Address - Country:US
Practice Address - Phone:785-409-1530
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-23
Last Update Date:2019-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS503237700000X
KS677231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologistGroup - Single Specialty
No237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument SpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS677OtherKS DEPARTMENT FOR AGING & DISABILITY SERVICES HEALTH OCCUPATIONS CREDENTIALING
KS503OtherKANSAS BOARD OF EXAMINERS IN THE FITTING AND DISPENSING OF HEARING INSTRUMENTS